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Annals of Surgical Oncology

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Postbiopsy Pigmentation is Prognostic in Head and Neck Melanoma

Becky B. T. King MD, Brandon C. Chapman MD, Ana Gleisner MD, PhD, Camille Stewart MD, Chloe Friedman MPH, Jennifer J. Kwak MD, Martin D. McCarter MD, Nicole Kounalakis MD
Volume 26, Issue 4 / April , 2019



To assess postbiopsy pigmentation (PBP) as a prognostic feature in patients with cutaneous head and neck (H&N) melanoma.


Retrospective review of patients undergoing sentinel lymph node biopsy (SLNB) for H&N melanoma (1998–2018). PBP was defined as visible remaining pigment at the scar or biopsy site that was documented on physical exam by both a medical oncologist and a surgeon at initial consultation. Variables associated with disease-free survival (DFS) and overall survival (OS) were analyzed using multivariable Cox proportional hazards models.


Among 300 patients, 34.3% (n = 103) had PBP and 44.7% (n = 134) had microscopic residual disease on final pathology after wide local excision. Prognostic factors associated with DFS included advanced age, tumor depth, ulceration, PBP, and positive SLNB (p < 0.05). Patients with PBP fared worse than their counterparts without PBP in 5-year DFS [44.1% (31.1–56.3%) vs. 73.0% (64.1–80.0%); p < 0.001] and 5-year OS [65.0% (50.0–76.6%) vs. 83.6% (75.7–89.2%); p = 0.005]. After multivariable adjustment, PBP remained associated with shorter DFS [hazard ratio (HR) 1.72, 95% confidence interval (CI) 1.01–2.93; p = 0.047], but was not prognostic of OS.


In patients with H&N melanoma, PBP is associated with significantly shorter DFS. Patients with PBP may warrant greater consideration for SLNB and closer postoperative surveillance.

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