Ulceration of a cutaneous melanoma on microscopic sections is an adverse prognostic finding. The five-year survival rate is reduced from 80% for non-ulcerated melanomas to 55% in the presence of ulceration for Stage I melanoma patients and from 53 to 12% for Stage II melanoma patients (P less than 0.001). As a group, ulcerated lesions are thicker and more likely to have a nodular growth pattern. However, survival rates were still worse for ulcerated melanomas when matched with nonulcerated lesions for thickness and stage of disease. The width but not the depth of surface ulceration significantly correlated with survival. The median ulcer depth was 0.08 mm (range 0.01-1.2 mm). In those few lesions with ulcer craters more than 0.2 mm in depth, the melanomas were so thick they had the same poor prognosis regardless of whether thickness was measured to the base of the ulcer or to the top of the lesion. The Breslow microstaging method of measuring thickness is therefore a valid prognostic indicator, even for ulcerated lesions. The incidence of ulceration for the entire patient group ranged from 12.5% for melanomas less than 0.76 mm thickness to 72.5% for melanomas greater than 4.0 mm thick (P of correlation = 0.0001); from 12% for Level II invasion to 63% for Level V lesions (P = 0.005); from 23% for superficial spreading growth patterns to 49% for nodular and 74% for polypoid lesions (P = 0.0001); and from 27% for lesions with a heavy lymphocyte infiltration to 60% for minimal or absent host response (P = 0.005). There was no significant correlation with anatomic location, pigmentation of the melanomas, or with the patient's age and sex. Since ulceration appears to have such an important influence on survival rates, this parameter should be considered as a stratification criterion in clinical trials and accounted for when analyzing results of melanoma treatment.

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Cytologic preparations from lymph nodes and lymphoid lesions in other tissues permit accurate intraoperative diagnosis of a number of lesions that are not commonly identifiable with certainty in conventional frozen sections. The clarity of cytologic detail in smears or imprints allows recognition of Hodgkin's and non-Hodgkin's lymphomas, certain metastatic tumors such as melanoma or oat cell carcinoma, and some nonneoplastic disorders, all of which must be diagnosed on the basis of cellular alterations. The characteristic cytologic features of these disorders are presented. Cytologic preparations also have proved valuable in evaluating lesions that usually can be diagnosed with frozen sections. For these lesions, the ability to see cytologic details provides greater diagnostic certainty. For some necrotic, calcified, or fatty specimens, smears or imprints are the only preparations possible. With alcohol fixation and rapid hematoxylin and eosin or Papanicolaou staining, the preparations are ready for examination within 2 minutes after the specimens are received. The cytologic presentations are essentially identical to those of aspiration biopsies. Use of each type of preparation helps develop and maintain the diagnostic skills needed for the other.

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