Prognostic variables in patients with thick melanomas. Analysis of 362 cases

Abstract

Background: Melanoma epidemiological and prognostic studies are based on Caucasian populations, in whom the predominant subtype is superficially-spreading melanoma and in whom thin melanomas (Breslow < 3 mm) predominate. Mexican patients show a predominance of thick melanomas (Breslow ≥ 3 mm), and the acral subtype is the most common. There are no publications on prognostic factors in thick melanomas. We hypothesize that we will identify factors that determine the prognosis in this group of patients. Objective: To identify clinical-pathological factors associated with the prognosis of patients with thick melanomas in the Mexican population. Material and methods: Data on melanomas with Breslow > 3 mm were collected from 2010 to 2015. The prognostic influence of various clinical-pathological factors was analyzed. Results: The most common subtypes were acral melanoma in 271 patients (74.9 %) and nodular melanoma in 49 (13.5 %). Median Breslow thickness was 7 mm. 56.6 % of the patients had lymph node metastases (clinical stage [CS] III), 269 (74.3 %) had ulceration, and surgical margins were positive in 15 (4.1 %). Elevated neutrophil: lymphocyte ratio (≥ 2) was found in 188 (51.9 %). The variables associated with lower overall survival were CS (p < 0.001), Breslow thickness (p = 0.044), ulceration (p = 0.004), mitotic activity (p < 0.001), < 2-cm margin (p < 0.001) and an increased neutrophil: lymphocyte ratio (p = 0.037). In the multivariate analysis, the factors associated with overall survival were CS, mitotic activity, and surgical margin. Conclusions: In patients with thick melanomas, overall survival is influenced by mitotic activity, a positive margin, and clinical stage.

The Impact of Clinical and Histopathological Factors on Disease Progression and Survival in Thick Cutaneous Melanomas

“…Nevertheless, not all thick melanomas behave the same way, and little is known about additional prognostic factors for such tumors. In our study population, the age of the patients was not correlated with progressive disease, and similar findings were noted by other authors [26,32,33]. In contrast, others demonstrated that increased age is an adverse prognostic factor in thick melanomas [34][35][36][37].…”

“…These findings are interesting as NM and ALM melanomas are generally associated with decreased survival and are an adverse prognostic factor for thick melanomas as well, being associated with sentinel lymph node metastases [25,38]. Nevertheless, the exact association between histological subtype and OS in thick melanomas remains to be determined, as some other studies found no correlation between the two [32,33].…”

Prognostic Value of the Width of Invasion in pT3 Cutaneous Melanomas

“…Nevertheless, within each particular stage based on Breslow depth, patient outcomes can vary significantly. For instance, in pT4 cutaneous melanomas, increasing Breslow depth continues to be correlated with PFS and OS [26,27,34,40]. For pT3 cutaneous melanomas (Breslow between 2 and 4 mm), we have demonstrated that increasing depth is correlated with PFS and OS on univariate analysis.…”

The Prognostic Value of Proliferative Activity in Cutaneous Melanoma: A Pilot Study Evaluating the Mitotic Rate and Ki67 Index to Predict Patient Outcomes

“…The independent prognostic value of the mitotic rate has been described in various studies [ 7 , 29 , 38 , 39 , 40 , 41 ]. Despite these results, there is still no consensus regarding the prognostic cut-off value for the number of mitoses as different studies have used various thresholds, such as absent vs. present, ≥1/mm 2 , ≥2/mm 2 , or 5 mitoses/mm 2 [ 1 , 42 , 43 , 44 , 45 ]. Moreover, the significant cut-off values may vary based on the tumor stage, and further studies are required to fully establish how the mitotic index should be reported in cutaneous melanomas [ 7 , 40 , 46 ].…”