Background: Head and neck cutaneous melanoma represents a distinct entity of skin cancers. In this study, we aim to examine the risk profile of head and neck cutaneous melanoma, and the overall survival of patients with such malignancy.

Methods: A retrospective cohort study utilizing the National Cancer Data Base, 2004 – 2012. Study population included adults (≥18 years) patients with either head & neck cutaneous melanoma (HNCM) (cases) or with other site cutaneous melanoma (OTCM) (controls).

Results: A total of 1,192 (16.0%) HNCM and 6,277 (84.0%) OTCM patients were included. The median follow-up time was 29.3 months (interquartile range: 16.1 – 52.4). As compared to OTCM, patients with HHCM were more likely to be ≥65 years old, male, and White or Hispanic other than Black (p<0.01 each). In patients with HNCM stages I&II, overall survival was improved in patients who underwent surgery with sentinel lymph node biopsy [HR: 0.63, 95%CI: (0.45, 0.88), p=0.006].  Similarly, patients with HNCM stage III had an improved survival if sentinel lymph node biopsy was performed [HR: 0.73, 95%CI: (0.62, 0.86), p<0.001], as well as for patients who received immunotherapy [HR: 0.46, 95%CI: (0.37, 0.57), p<0.001]. Patients with private insurance were more likely to receive immunotherapy than patients with other types of insurance (p<0.001).

Conclusions: Older age, male, and White or Hispanic racial backgrounds are associated with a higher risk of head and neck cutaneous melanoma. Sentinel lymph node biopsy is associated with improved survival in patients with HNCM. There is an insurance-based disparity in the utilization of immunotherapy.