Prognostic factors in head and neck melanoma according to facial aesthetic units

BACKGROUND: Head and neck melanoma is a clinical challenge. Indeed, cutaneous head and neck melanoma shows a worse prognosis in comparison to melanomas of other body sites. Although the emphasis on facial cosmetic preservation plays a pivotal role in comparison to other body areas, specific facial aesthetic units could also play a key role in the prognostic evaluation of the malignancy. METHODS: The aim of the current study was to evaluate the general outcome and clinicopathological features of head and neck melanoma and to detect prognostic differences according to each facial aesthetic unit. The Kaplan-Meier product was used to calculate survival curves, while Cox proportional-hazard regression was performed to evaluate the predictive value of each facial aesthetic unit. RESULTS: A total of 221 head and neck melanoma patients was included in our analysis. In the nasal facial aesthetic unit, we found a high rate of local recurrence, which affected significantly disease free survival. The worse prognosis was observed in melanoma of the scalp, which showed a greater tendency to skip metastases in internal organs. Moreover, we found that scalp showed a low incidence of non-melanoma skin cancers, if compared to other facial aesthetic unit, highlighting that the scalp local milieu might play a more prominent role in melanoma biology than chronic UV exposition. CONCLUSIONS: Although facial aesthetic units have an aesthetic function, they could also play a role in the evaluation and follow-up of melanoma