Prognostic factors in cutaneous malignant melanoma: A comparative study of long term and short term survivors

Abstract

The clinical presentation and histologic characteristics of primary melanomas of a consecutive series of 100 short term (fatal within five years) and 100 long term survivors (disease-free for ten years or longer) were studied. The clinical parameters analyzed included the history of pre-existent mole, duration of changes before diagnosis, site, elevation, ulceration, extent of pigmentation, and satellitosis around the primary lesion. Study of histologic features included analysis of exact measurements of the primary melanoma, depth of dermal invasion, tumor cell morphology, mitotic rate, intracellular pigmentation, presence or absence of giant tumor cells, blood vessel or lymphatic invasion, lateral junctional activity, and presence and extent of lymphoid response to the primary lesion. Statistically significant differences were found between the long term and short term survivors with respect to several variables. It is one of the conclusions of this study that an elective node dissection would seem to be indicated in all patients with stage I melanoma who present with poor prognostic signs, that is, patients who belong to any combination of the following categories: male, primary lesions>1 cm., which has ulcerated, with a deeper level of dermal penetration, with dermal lymphatic or blood vessel invasion, and a lack of lymphoid reaction around the primary lesion.