Faculty Bibliography

Objectives: To report changes in survival probabilities as patients survive one or more years with head and neck melanoma, and to characterize prognostic factors for this conditional survival statistic. Study Design: Retrospective population-based cohort study. Methods: All subjects from the Surveillance, Epidemiology and End Results (SEER 17) database of the National Cancer Institute with head and neck cutaneous melanoma were analyzed. Using the life table actuarial method, conditional 5 year disease specific survival (DSS) and relative survival were determined for patients surviving one to ten years after diagnosis. Grouped comparisons were performed for anatomic subsites within the head and neck and the rest of the body. Probabilities were also stratified by histologic subtype, thickness of invasion and lymph node status. Results: Five year DSS for scalp and neck melanomas increases from 83.1% to 93.9% for patients surviving five years, compared to an increase from 89.2% to 96.2% for other anatomic sites. Nodular melanoma displayed the worst initial survival among histologic subtypes (73.4%) but improves to 91% at five years. Conditional DSS for node positive patients improves from 47.9% to 83.1%. Survival at diagnosis is stratified by tumor thickness from 96.7% (T1) to 62.3% (T4), but tends to converge between five to ten years of survivorship. Conclusions: For patients with head and neck melanoma who have survived several years, conditional survival provides accurate and useful prognostic information. In general, expected survival increases with time survived since diagnosis, and for low and high T-stage patients, conditional survival statistics converge over time

The vertical rectus abdominus myocutaneous (VRAM) flap is a valuable option for tongue reconstruction. However, the traditional inset (skin to remaining oral mucosa) obviates a more anatomic reconstruction. Eight patients underwent total or subtotal glossectomy with VRAM reconstruction. The muscle inset was supported at the inferior mandibular border attached to the remaining lingual mucosa or gingiva. The neotongue, consisting of skin and subcutaneous fat, was sutured posteriorly to the remaining tongue base, and the other surfaces were trimmed and left unsutured. Reconstruction was successful in all patients. The neotongue assumed palatal configuration, and within 2 weeks uniform granulation tissue followed by mucosalization occurred. One year postoperatively, all patients tolerated ad lib diets, spoke intelligibly, were gastrostomy tube and tracheotomy free and had no evidence of aspiration. This neotongue sits on the mandible under voluntary control, permitting effective obturation against the hard palate and providing successful speech and swallowing

BACKGROUND: Histologic diagnosis of mucosal melanoma of the head and neck is difficult, requiring immunohistochemical stains which are less reliable than in cutaneous lesions. PNL-2 is a novel marker that has not been examined in mucosal melanoma. METHODS: Nine formalin-fixed tissue sections of mucosal melanoma were stained with PNL-2, human melanoma black (HMB)-45, Melan-A, S-100, and microphthalmia transcription factor (MITF). RESULTS: Disease in all 9 patients arose from the sinonasal mucosa. Rates of diffuse positive staining with the 4 stains were PNL-2 (77.8%), HMB-45 (77.8%), Melan-A (50%), S-100 (87.5%), and MITF (40%). In 3 patients, PNL2 staining was superior to Melan-A or MITF. CONCLUSION: We report the first characterization of PNL-2 staining in head and neck mucosal melanoma. PNL-2 demonstrates high sensitivity for mucosal melanoma, likely superior to Melan-A and MITF, and comparable to HMB-45, with specificity superior to S-100. We advocate inclusion of PNL2 as an important adjunctive marker in the evaluation of these lesions. (c) 2008 Wiley Periodicals, Inc. Head Neck, 2008

BACKGROUND: The incidence of thyroid cancer in black Americans is half that in white Americans. It is unknown whether this gap represents a population difference in disease or is attributable to inferior cancer screening in the black population. METHODS: A population-based cohort study of 53,990 patients (1973-2003) was performed using the National Cancer Institute's Surveillance Epidemiology End Results database. Socioeconomic variables were explored using the Healthcare Cost and Utilization Project database and macroeconomic data. RESULTS: Since 1973, thyroid cancer incidence among whites has increased 150.2% (4.0 to 9.9 of 100,000), while incidence among blacks has increased 73.2% (3.0 to 5.1 of 100,000). Across 17 regions, the incidence correlated with the percentage of the population with health insurance (r = 0.56, P = .02). Regression analysis suggested that half of the black-white incidence gap might be attributable to differences in health insurance status. Patients with thyroid cancer were more likely to be insured or reside in wealthier ZIP codes. Black patients were more likely to present at advanced age (RR 1.08, P < .0001) and with tumors >4 cm in size (RR 1.13, P <.0001). Black patients were slightly less likely to present with advanced disease (RR 0.96, P = .0008). Cancer-specific mortality was identical in the two populations. DISCUSSION: Sociodemographic data and differences at presentation support a small detection disparity in thyroid cancer, which may contribute to part of the incidence gap. However, this effect is not sufficiently strong to fully explain the incidence gap. A population difference in the incidence of disease may be coexistent