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Background: The staging of mucosal melanoma of the head and neck (MMHN) has been unsatisfactory. Whilst the American Joint Committee on Cancer (AJCC) staging system for cutaneous melanoma is long established, staging for MMHN was only introduced in the 7 th edition of the AJCC Staging System (AJCC7). Emerging evidence indicates only limited prognostic utility of AJCC staging for patients with MMHN. The current 8 th edition (AJCC8) reflects this uncertainty for MMHN, and (unlike AJCC7) omits prognostic stage groups for MMHN, maintaining only TNM categories.

For MMHN, AJCC staging commences at T3, unlike any other disease. However, it remains unclear if staging MMHN from T3 onwards brings closer the survival outcomes of MMHN and those of cutaneous melanoma of the head and neck (CMHN) for matched stages. Despite differences in incidence, presentation, and biological behavior …