The prognostic significance of ulceration of cutaneous melanoma

Abstract

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.

Comparison between lentigo maligna melanoma and other histogenetic types of malignant melanoma of the head and neck

“…The survival profiles for the four sex/ulceration subgroups clearly demonstrated that increasing tumour thickness reduced survival prospects in all four groups. Ulceration is a significant predictive factor in many studies that have controlled for tumour thickness (Balch et al, 1978(Balch et al, , 1980Van der Esch, 1981;Day et al, 1982b;Urist et al, 1984;Shaw et al, 1985;O'Brien et al, 1991;Andersson et al, 1993;Langford et al, 1993;MacKie et al, 1995) and even retains significance in patients with lymph node metastasis (Balch et al, 1980). Male sex has been associated with poorer prognosis in most studies of head and neck melanoma (Ballantyne, 1970;Fitzpatrick et al, 1972;Hansen and McCarten, 1974;Gussack et al, 1983;Cox et al, 1987;O'Brien et al, 1991;Langford et al, 1993;Ringborg et al, 1993;Andersson et al, 1993), although some studies report no sex difference (Catlin, 1966;Knutson et al, 1972;McGovern et al, 1980) and one reported a better prognosis in men (Southwick et al, 1963).…”

Cutaneous malignant melanoma in Scotland

“…The work of Clark, Breslow, Balch and their associates in the past decade has greatly extended the volume of useful information, often of considerable prognostic significance, which can be obtained from light-microscopic examination of appropriate blocks of paraffin-embedded tissue (Clark et al, 1969;Breslow, 1977;Breslow & Macht, 1978;Balch et al, 1978Balch et al, , 1979Balch et al, , 1980. Clark has suggested that there are several different histogenetic precursors or lateral growth phases of the pre-invasive epidermal component of cutaneous malignant melanoma.…”

Prognosticators of melanoma, the melanoma report, and the sentinel lymph node

“…By convention we measure the size of any ulcer. 93 The five year survivorship in Stage I-II melanomas decreased from 80 to 55% in the presence of ulceration and for Stage III melanomas dropped from 53 to 12%. The majority of melanomas greater than 4.0 mm in thickness are ulcerated.…”