Prognostic factors and treatment outcomes in 444 patients with mucosal melanoma

• Published in: European journal of cancer (1990) Vol. 81; pp. 36 - 44
• Main Authors: Heppt, Markus V., Roesch, Alexander, Weide, Benjamin, Gutzmer, Ralf, Meier, Friedegund, Loquai, Carmen, Kähler, Katharina C., Gesierich, Anja, Meissner, Markus, von Bubnoff, Dagmar, Göppner, Daniela, Schlaak, Max, Pföhler, Claudia, Utikal, Jochen, Heinzerling, Lucie, Cosgarea, Ioana, Engel, Jutta, Eckel, Renate, Martens, Alexander, Mirlach, Laura, Satzger, Imke, Schubert-Fritschle, Gabriele, Tietze, Julia K., Berking, Carola
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.08.2017; Elsevier Science Ltd
• Subjects: Adult; Aged; Aged, 80 and over; Anorectal; Antineoplastic Agents - therapeutic use; Cancer; Combined Modality Therapy; Diagnosis; Female; Genital tract; Head; Head and neck; Health risks; Hematology, Oncology and Palliative Medicine; Humans; Immune checkpoint blockade; Male; Medical prognosis; Melanoma; Melanoma - mortality; Melanoma - pathology; Melanoma - therapy; Metastases; Middle Aged; Mucosa; Mucosal melanoma; Mucous Membrane - pathology; Mutation; Neoplasms - mortality; Neoplasms - pathology; Neoplasms - therapy; Parameter identification; Patients; Prognosis; Regression Analysis; Retrospective Studies; Risk analysis; Risk Factors; Skin cancer; Skin diseases; Staging; Survival; Survival Analysis; Targeted therapy; Tumors; Young Adult; Prognosis; Immune checkpoint blockade; Targeted therapy; Staging; KIT; Survival; Mucosal melanoma
• ISSN: 0959-8049; 1879-0852; 1879-0852
• DOI: 10.1016/j.ejca.2017.05.014

Mucosal melanoma (MM) is a rare but diverse cancer entity. Prognostic factors are not well established for Caucasians with MM. We analysed the disease course of 444 patients from 15 German skin cancer centres. Disease progression was determined with the cumulative incidence function. Survival times were estimated with the Kaplan–Meier method. Prognostic parameters were identified with multivariate Cox regression analysis. Common anatomic sites of primary tumours were head and neck (MMHN, 37.2%), female genital tract (MMFG, 30.4%) and anorectal region (MMAN, 21.8%). MMAN patients showed the highest vertical tumour thickness (p = 0.001), had a more advanced nodal status (p = 0.014) and a higher percentage of metastatic disease (p = 0.001) at diagnosis. Mutations of NRAS (13.8%), KIT (8.6%) and BRAF (6.4%) were evenly distributed across all tumour site groups. Local relapses were observed in 32.4% and most commonly occurred in the MMHN group (p = 0.016). Male gender (p = 0.047), advanced tumour stage (p = 0.001), nodal disease (p = 0.001) and incomplete resection status (p = 0.001) were independent risk factors for disease progression. Overall survival (OS) was highest in the MMFG group (p = 0.030) and in patients without ulceration (p = 0.004). Multivariate risk factors for OS were M stage at diagnosis (p = 0.002) and incomplete resection of the primary tumour (p = 0.001). In this large series of MM patients in a European population, anorectal MM was associated with the poorest prognosis. •Four hundred forty-four patients with mucosal melanoma of all anatomic sites are reported.•The most common tumour sites were head and neck, female genital tract and anorectum.•A tumour thickness > 2 mm and ulceration were prognostically relevant parameters.•Complete primary tumour resection improved progression-free and overall survival.