Patients with cutaneous head and neck melanoma receiving immune checkpoint inhibitors had significantly improved melanoma-specific and overall survival rates compared with those with melanomas from other body sites, according to a recent study. 

A retrospective study investigated differences in clinicopathologic features and treatment outcomes between cutaneous head and neck melanoma (CHNM) and cutaneous melanoma of other sites (CMOS). The study, published in the Journal of the American Academy of Dermatology, analyzed 13,644 patients treated between 2000 and 2018, providing key insights into the distinct biological and clinical behavior of CHNM.

The investigators included patients diagnosed with CHNM (n = 3,007) and CMOS (n = 10,637), excluding those with melanoma in situ or multiple primary melanomas. Data were derived from a prospectively maintained database, and survival outcomes were assessed using the Kaplan-Meier method. Cox regression analyses examined prognostic factors, while propensity score-matched analyses validated findings.

Patients with CHNM were older at diagnosis (median age = 65.9 years vs 58.5 years, P < .001) and predominantly male (69.0% vs 54.1%, P < .001) compared with CMOS. CHNM tumors had significantly worse prognostic features, including greater Breslow thickness (median = 1.7 mm vs 1.2 mm, P < .001), higher ulceration rates (21.2% vs 18.2%, P < .001), and increased tumor mitotic rates (median 3 vs 2 mitoses/mm², P < .001). Desmoplastic and lentigo maligna melanoma subtypes were more prevalent in CHNM (P < .001).

Survival analyses revealed poorer locoregional control and distant metastasis-free survival in CHNM (hazard ratios [HR] = 1.17 and 1.25, respectively, both P < .001). However, there were no statistically significant differences in melanoma-specific survival (MSS) and overall survival (OS) between the groups. Among patients with stage IV disease treated with immune checkpoint inhibitors (ICIs), CHNM was associated with greater MSS (HR = 0.56, P = .001) and OS (HR = 0.57, P < .001) compared with CMOS.

The study identified distinct clinicopathologic features of CHNM, including poorer locoregional control and distant metastasis-free survival but better outcomes with ICIs compared with CMOS. Limitations included the retrospective design and missing data, and the investigators suggested that future research on CHNM’s molecular mechanisms could refine treatment approaches.

Full disclosures can be found in the published study.