Therapeutic and clinico-pathological factors in the survival of 1,469 patients with primary cutaneous malignant melanoma in clinical stage I

Abstract

Therapeutic and clinico-pathological data of 1,469 patients with clinical stage I malignant melanoma of the skin without histological evidence of fibrotic areas of regression were examined by multivariate regression analysis. In accordance with a previous analysis anatomical site of tumour, tumour thickness, level of invasion, mitotic rate, ulceration, lymphocytic reaction, dominant type of invasive tumour cell, and sex were found to act as independent risk factors. The present analysis, furthermore, showed that size of resection margin, diagnostic biopsy, removal of the deep fascia, age at surgery, as well as presence and depth of nevus cells did not influence prognosis when adjusting for the independent risk factors.

Vascular Involvement in the Prognosis of Primary Cutaneous Melanoma

“…For instance, several studies from large databases of patients with melanoma show conflicting results with respect to the importance of vascular invasion. [7][8][9][10][11][12] Studies analyzing the role of vascular invasion in melanoma have been hampered by small patient numbers, inadequate follow-up, and/or the use of different techniques for optimal recognition of these tumor cell-tumor vasculature interactions. 13,14 As a result, the presence of vascular invasion is not routinely documented in melanoma pathology reports.…”

Cutaneous melanoma: estimating survival and recurrence risk based on histopathologic features

“…Over the last few decades, its use as a single variable has appropriately supplanted that of levels of invasion, as several studies have indicated that levels add little information to thickness in large series of melanoma cases. However, level has been identified as an independent variable (in addition to thickness and other attributes) in several studies (15–18,22), as discussed previously.…”

“…In another recent analysis, level of invasion was one of four independent prognostic factors, along with thickness, ulceration, and mitotic rate (16). In a study of 1469 cases, the independent prognostic factors included tumor thickness, levels of invasion, patient gender, lesional location, mitotic rate, tumor cell type (spindle versus other), and lymphocytic response (17). These findings, as well as those from other recent studies, suggest that levels may continue to provide useful prognostic information (18,19).…”

“…(85), have identified subgroups at substantially increased risk within this category. In particular, based on available recent studies, as well as a large amount of older literature (2,8,17,33,58,59,85–95), it seems clear that the property of “mitogenicity” (the presence of any mitoses in the dermal component of the melanoma) is an important prognostic factor for thin lesions, and it should be considered as a useful modifier of AJCC stage 1 to identify thin lesions with a worse prognosis, for which additional management (such as sentinel lymph node staging) might be considered.…”

Cutaneous melanoma: methods of biopsy and definitive surgical excision

“…Although a trend was shown to favor those patients in whom the fascia was removed, the incidence of subsequent recurrence, site of recurrence, and overall survival were not statistically significant between the two groups. These findings have been confirmed in a study by Sondergaard et al., who analyzed 1469 patients with primary cutaneous melanoma and found that removal of the deep fascia did not influence prognosis (35). Removal of the muscular fascia is generally associated with minimal morbidity and should probably be performed for thick melanomas to ensure tumor‐free deep margins.…”