[477] The National Impact of the Rising Incidence of Scalp Melanoma in Central Texas

Cary Chisholm, Chad Housewright, John F Greene, Charles Verheyden. Scott & White Memorial Hospital, Temple, TX

Background: Melanoma is a particularly aggressive form of skin cancer that has a fluctuating prognosis depending on the depth of invasion and site of origination. The head and neck region, specifically the scalp, has been described by several authors as the anatomic location with the highest morbidity and mortality, and several epidemiological causes for the poor prognosis have been proposed. These include the presence of hair obscuring visual inspection of the scalp, more intense and prolonged exposure to the sun, as well as increased vasculature and lymphatic drainage allowing for rapid metastasis. With such a significant proportion of the United States population reaching the age distribution of this malignancy, we sought to specifically evaluate melanomas occurring in the hair-bearing portion of the scalp.
Design: To accomplish our stated objectives, we examined 35 patients with scalp melanoma diagnosed between 1976 and June, 2009. A retrospective chart review was performed after permission was obtained from the Institutional Review Board. We collected data pertaining to the patient demographics and tumor characteristics.
Results: The mean age at diagnosis was 69 years. Scalp melanoma was diagnosed in males more than 6 times as frequently as in females. Superficial spreading melanoma was the most common subtype. Seven patients (20%) expired due to metastatic melanoma with a median overall survival of 3.4 years. When compared to patients who survived or those who died of unrelated causes, those patients who expired due to melanoma progression exhibited different characteristics.

Patient Characteristics

	Age	Breslow Depth	Ulceration	Tumor-Infiltrating Lymphocytes
Died of Melanoma	70.4	2.11 mm	2 of 7 (28.6%)	2 of 6 (33.3%)*
Others	69	1.79 mm	3 of 28 (10.7%)	16 of 27 (59.3%)*

*One patient in each group had no mention of tumor-infiltrating lymphocytes in the pathology report, and no tissue was available for review.


Conclusions: The extraordinary increase in scalp melanoma diagnoses and significantly higher mortality rate is troublesome and deserves multidisciplinary recognition and action for the health of our aging population. The mortality rate from invasive melanoma in our series was 2.3 times the published overall rate for all melanomas as provided by Surveillance Epidemiology and End Results (SEER)(20% versus 8.8%). The rising incidence of this more lethal melanoma suggests more rigorous screening is indicated for scalp melanoma.
Category: Dermatopathology

Wednesday, March 21, 2012 1:00 PM

Poster Session VI # 98, Wednesday Afternoon