EVALUATION OF THE PROGNOSTIC-SIGNIFICANCE OF THE SITE OF ORIGIN OF CUTANEOUS MELANOMA

The prognostic significance of the BANS region (Back, Arms, Neck, Scal p) in primary cutaneous melanoma remains controversial. We hypothesize d that the different anatomic sites of the BANS region may have differ ent prognostic significance. As the anatomic areas examined have varie d between reports on BANS or head and neck melanomas, these difference s could explain the lack of consistent findings. Between 1971-1990 mor e than 5000 patients with Stage I (n = 2576) and Stage II (n = 852) cu taneous melanoma were treated at the UCLA Medical Center. Patients wer e stratified for analysis into the following anatomic categories: scal p, neck, upper back, arm, and other anatomic sites. Initial analysis r evealed that Clark's level of invasion, tumor thickness, gender, and n umber of positive nodes were predictive of survival. Controlling for t hese variables, the impact of the site of origin on prognosis was eval uated. Five-year actuarial survival in Stage I patients was as follows : scalp-80 per cent, neck-92 per cent, upper back-90 per cent, arm-94 per cent, all others-89 per cent. There were no significant survival d ifferences between these groups, although the poorer survival for scal p primaries approached statistical significance (P = 0.084). In Stage II disease, however, marked survival differences were noted between an atomic sites. Median survival for Stage II patients was as follows: sc alp -25 months, neck -28 months, upper back -38 months, arm -75 months , all others -67 months (P = 0.005). These results indicate that anato mic site of origin does affect prognosis in patients with nodal metast ases.