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Scalp and neck melanomas are associated with poorer prognosis when compared with melanomas of other sites with 5- and 10-year Kaplan-Meier survival probabilities of 83 and 76 per cent compared with 92 and 89 per cent, respectively.1 Although accounting for only six per cent of all melanomas, scalp and neck melanomas accounted for 10 per cent of all deaths and were associated with older age, male gender, greater thickness, presence of ulceration, and positive lymph nodes.1 Melanoma of the scalp and neck is associated with a mortality rate 1.84 times greater than melanoma of the extremities in an adjusted model.1 However, the basis of site-specific rate of mortality is not well understood.
Recent anatomic studies demonstrate that lymphatic vessels in the head and neck comprise a complex lymphatic draining system in which lymphatic vessels among the same group may drain to different lymph nodes.2 Given the uniqueness of the lymphatic drainage system of the head and the poor prognosis in patients with melanoma of the scalp, we hypothesized that melanomas of the scalp have different rates of intransit metastasis (ITM) compared with melanomas from other regions of the body. In this study, we sought to better characterize the presence of ITM in scalp melanomas. We compared the rates of ITM in scalp melanomas with rates of ITM in lower extremity melanomas. A better understanding of the role of anatomic site in melanoma prognosis is important for the promotion of effective public health messages.
We performed a retrospective case-controlled study of all scalp melanomas heated surgically by...