Non-radical primary diagnostic biopsies affect survival in cutaneous head and neck melanoma

Abstract

Background

It is unclear if a non-radical diagnostic biopsy entails a higher risk for metastasis and poorer survival for patients with cutaneous head and neck melanoma (cHNM).

Aims/objectives

To assess whether or not initial diagnostic biopsy modality and radicality (clear, positive, or narrow histopathological margins) influence recurrence and survival in patients with cHNM.

Materials and methods

Histopathological radicality of initial diagnostic biopsies and outcome for 368 consecutive cHNM patients, clinically asymptomatic of metastatic disease and referred to a tertiary care academic center for sentinel lymph node staging from 2004 through 2018, were retrospectively analyzed.

Results

Patients with positive (n = 133) or narrow (0.1–0.5 mm) (n = 34) histopathological margins had significantly worse loco-regional (p=.004) and distant control (p=.004) as well as lower overall (p=.017) and melanoma specific (p=.0002) survival than 201 patients with clear margins. Multivariate analysis indicated positive or narrow histopathological margins as independent negative prognostic factors for melanoma specific survival (HR 2.16, p=.015), together with deeper Breslow (HR 1.17, p=.00001) and ulceration (HR 2.49, p=.003).

Conclusions and significance

Non-radical primary diagnostic biopsies increase the risk for metastatic disease and impair survival in cHNM. Accordingly, radical melanoma diagnostic procedures should be encouraged in the head and neck region when possible.

Chinese abstract

背景：尚不清楚非彻底性诊断活检是否会引起头颈部皮肤黑素瘤（cHNM）患者转移风险更高以及存活率更低。

目的：评估初始诊断性活检的方式和程度（组织病理特征清楚 , 阳性或狭窄的边缘）是否会影响cHNM患者的复发和生存率。

材料和方法：回顾性分析了368例连续的cHNM患者的初始诊断性活检的组织病理学程度和结果, 他们无临床转移性疾病, 2004年至2018年间转诊至三级护理学术中心进行前哨淋巴结分期。

结果：组织病理学边缘为阳性（n¼133）或狭窄（0.1-0.5 mm）（n¼34）的患者局部区域和远距离对照（p¼.004）明显较差, 且总体存活率（p¼.017）和黑色素瘤特异的存活率（p¼.0002）低于201例有清楚切缘的患者。多变量分析表明阳性或狭窄的组织病理学边缘, 以及更深的Breslow（HR 1.17, p¼.00001）和溃疡（HR 2.49, p¼.003）, 是黑色素瘤特异性生存的独立阴性预后因素(HR 2.16, p¼.015)。

结论和意义：非彻底性初始诊断活检增加了转移风险并影响了cHNM患者的生存。因此, 在可能的情况下, 应鼓励在头颈部区域进行彻底的黑色素瘤诊断程序。

Keywords:

• Cutaneous melanoma
• histopathological margins
• head and neck
• radicality
• diagnostic biopsy

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This study was supported by grants from ‘Konung Gustaf V:s och Drottning Victorias Frimurarestiftelse’ and ‘Stiftelsen Acta Otolaryngologica’ in Sweden.