Patients with scalp or neck melanomas die at nearly twice the rate of people with melanomas at other locations including the face and ears, according to an article in the April issue of the Archives of Dermatology.

Researchers at the University of North Carolina at Chapel Hill analyzed data for 51,704 melanoma cases in the U.S. Patients with scalp or neck melanomas had a mortality rate 1.84 times higher than those with melanomas elsewhere after controlling for possible influences of age, gender, tumor thickness and ulceration.

"Scalp and neck melanoma patients have a higher rate of death than patients with melanoma anywhere else on the body," said Nancy Thomas, M.D., Ph.D., associate professor of dermatology in the UNC School of Medicine, a member of the UNC Lineberger Comprehensive Cancer Center and the study's senior author. Anne Lachiewicz, a medical student in the UNC School of Medicine, is the lead author of the study.

Thomas recommended that physicians pay special attention to the scalp when examining patients for signs of skin cancer. "Only six percent of melanoma patients present with the disease on the scalp or neck, but those patients account for 10 percent of melanoma deaths. That's why we need to take extra time to look at the scalp during full-skin examinations," she said.

The study helped to address the question among cancer researchers whether scalp and neck skin cancer is more lethal primarily because it is diagnosed later than other melanomas or there is biological significance to location.

"That was the thinking of a lot of people in the field (that scalp and neck cancers are identified later)," Thomas said.

"We think there's something different about scalp and neck melanomas," Thomas said. "This gives us directions for research to look at tumor cell types in those areas at the molecular level and to see if there are differences. I'm interested in identifying the mutations that drive malignancy."

Thomas, Lachiewicz and their colleagues analyzed data from 13 National Cancer Institute Surveillance Epidemiology and End Results (SEER) Program registries in nine states. Each case represented the first invasive melanoma diagnosed among non-Hispanic white adults between 1992 and 2003.

Patients with scalp or neck melanomas were older (59 years) than patients with other melanomas (55 years), and more likely to be male (74 percent versus 54 percent, respectively). In addition, scalp and neck melanomas were thicker (0.8 millimeters) than melanomas at other sites (0.6 millimeters) and more likely to be ulcerated. Lymph node involvement was also more common in patients with scalp-neck melanomas.

Melanomas on the extremities or on the face or ears had the best prognosis. The five-year melanoma-specific survival rate for patients with scalp or neck melanomas was 83 percent compared with 92 percent for patients with melanomas at other sites.

The ten-year survival rate was 76 percent for scalp or neck melanomas and 89 percent for other melanomas.