Clinically node-negative head and neck mucosal melanoma: An analysis of current treatment guidelines & outcomes.
OBJECTIVES
To analyze head and neck mucosal melanoma (MM) treatment patterns, and their association with survival, relative to National Comprehensive Cancer Network (NCCN) guidelines.


MATERIAL & METHODS
Adult head and neck MM patients with clinically-staged T3/4aN0 disease were identified in a retrospective analysis of the National Cancer Database (2010-2014) and stratified into sinonasal cavity (SN) and oral cavity, oropharynx, larynx, or hypopharynx (non-SN) cohorts.


RESULTS
We identified 353 SN and 79 non-SN MM cases. The majority of patients were treated with surgery (SN: 92.4%; non-SN 84.8%), within NCCN guidelines. Treatment within the non-SN MM NCCN recommendation of elective neck dissection (END) was approximately 26.6%. END is not recommended for SN MM and was not performed in 91.5% of cases. Radiotherapy (RT) is recommended in both SN and non-SN MM and was utilized in 63.5% of SN patients and 46.8% of non-SN patients. END was not independently associated with OS compared to surgery alone (SN HR: 1.350 [95% CI: 0.733-2.485]; non-SN HR: 3.460 [95% CI: 0.912-13.125]). RT was independently associated with improved OS in SN MM cases (HR: 0.679 [95% CI: 0.479-0.963]), but not in non-SN MM cases (HR: 0.824 [95% CI: 0.331-2.051]).


CONCLUSION
The majority of patients with head and neck MM are not treated within NCCN guidelines. The use of recommended END in non-SN patients is low. Similarly, adjuvant RT utilization is low. Our analysis shows that while greater use of RT may increase survival rates in this disease, the utility of END is unclear.
['Torabi|Sina J|SJ|', 'Benchetrit|Liliya|L|', 'Spock|Todd|T|', 'Cheraghlou|Shayan|S|', 'Judson|Benjamin L|BL|']
D000293:Adolescent D000328:Adult D000368:Aged D000369:Aged, 80 and over D003131:Combined Modality Therapy D016208:Databases, Factual D019468:Disease Management D005260:Female D006258:Head and Neck Neoplasms D006801:Humans D053208:Kaplan-Meier Estimate D008198:Lymph Nodes D008297:Male D008545:Melanoma D008875:Middle Aged D009092:Mucous Membrane D009367:Neoplasm Staging D017410:Practice Guidelines as Topic D010818:Practice Patterns, Physicians' D011379:Prognosis D016016:Proportional Hazards Models D016896:Treatment Outcome D055815:Young Adult
Melanoma Neck dissection Radiotherapy Antineoplastic protocols Head and neck cancer Treatment adherence Treatment outcome