Risk of brain metastasis in head and neck melanoma

The authors analyzed the risk factors for developing brain metastasis in head and neck melanoma. 

Head and neck melanomas occur in 15-20% of all skin melanomas. Head and neck melanoma often spread (metastasis) to the brain, resulting in poor survival time. The chance of developing brain metastasis in head and neck melanoma is higher than that in trunk (main body) and limb melanoma. Some of the risk factors associated with brain metastasis in head and neck melanomas are male sex, younger age, faster growth of cancer cells and tumor thickness (how far the tumor reaches deep into the skin).

Evaluating the occurrences of brain metastasis in a larger group would help determine specific risk factors. This might help to improve follow-up strategies in head and neck melanoma. 

The authors aimed to analyze the occurrence and the risk factors associated with brain metastasis in head and neck melanoma.

1,687 head and neck melanoma patients and 8,793 trunk and limb melanoma patients participated in this study. All patients had stage I or II melanoma (cancer that has not spread to other parts of the body) at the time of diagnosis. The average follow-up time was 83.3 months for head and neck melanoma and 89.2 months for trunk and limb melanoma.

The occurrence of brain metastasis in head and neck melanoma 5-years after diagnosis was 6.7% compared to 4.7% in trunk and limb melanoma. 12.7% of patients who had scalp (the skin covering the head but not the face) melanoma were likely to develop brain metastasis. Patients with ulceration (tumor breaking through skin’s surface) had a 2.25 increased risk of experiencing brain metastasis. Patients with scalp melanoma had an 80% increased risk of experiencing brain metastasis compared to all other head and neck locations.

The independent risk factors for brain metastasis with head and neck melanoma were tumor thickness, ulceration and location of tumor in the scalp.

The authors concluded that the occurrence of brain metastasis was higher in head and neck melanoma compared to trunk and limb melanoma. They also found that among head and neck melanoma, patients with scalp melanoma had the highest occurrence of brain metastasis.  

The follow-up time may not have been consistent between patients.