Scalp melanoma presents with greater Breslow thickness and higher metastatic burden: analysis of 105 Korean cutaneous head and neck melanoma patients

Cutaneous head and neck melanoma (CHNM) accounts for a disproportionate share of melanoma-related mortality, yet the prognostic value of its precise anatomical site remains uncertain. We retrospectively reviewed 105 patients with CHNM diagnosed at Chonnam National University Hwasun Hospital between 2002 and 2023. Variables were compared across four sites (scalp, face, neck, ear), and overall survival (OS), melanoma-specific survival (MSS), and recurrence-free interval (RFI) were analyzed using Kaplan-Meier methods and multivariable Cox proportional hazards models. Scalp melanomas arose in younger patients yet displayed the greatest Breslow thickness. Distant metastasis occurred during follow-up in 67% of scalp and 64% of all nonfacial melanomas, compared with 19% of facial melanomas. By Kaplan-Meier analysis, OS and MSS did not differ significantly by anatomic site (log-rank P = 0.18 and P = 0.11), whereas RFI differed across subsites (log-rank P < 0.001), with lower RFI for scalp than face in multiplicity-adjusted pairwise comparisons (adjusted P = 0.002). In multivariable Cox models, Breslow thickness remained independently associated with poorer OS [hazard ratio: 1.457, 95% confidence interval (CI): 1.235-1.719, P < 0.001), MSS (hazard ratio: 1.700, 95% CI: 1.414-2.045, P < 0.001), and RFI (hazard ratio: 1.195, 95% CI: 1.087-1.329, P < 0.001). Overall, scalp melanomas presented with the greatest Breslow thickness and higher metastatic burden, whereas Breslow thickness remained the primary independent prognostic factor for MSS and RFI in Korean patients with CHNM.