Breslow Tumor Thickness Research Articles

Analysis of Breslow tumor thickness distribution of skin melanoma in the Italian region of Romagna, 1986-1991.

In southern European countries, the availability of epidemiologic data on cutaneous malignant melanoma is limited. A descriptive analysis was performed on melanoma cases diagnosed in the Italian region of Romagna (population 600,000), 1986-91. The main end point was the proportion of cases less than 1.5 mm thick by sex, age, and site. A total of 297 incident cases was evaluated. The average annual age-standardized (World) incidence rates were 6.2 (95% CI 5.2-7.2) per 100,000 females and 4.5 (95% CI 3.6-5.3) per 100,000 males. Females presented with significantly thinner melanomas than males. The proportion of cases less than 1.5 mm thick decreased significantly with increasing age in both sexes, with the most pronounced decrease (approximately from 2/3 to 1/3) being observed above 60 years for females and above 40 for males. Comparing sexes by 10-year age groups, a significant F:M advantage in thickness distribution was found only at age 40-49 and 50-59 years. Among females under 60, melanomas of the legs and those of the trunk showed no difference in thickness distribution. In both sexes, incidence appeared to increase progressively with age. No apparent elevation in incidence rates was observed in the age groups with the highest frequency of thin melanomas. The major implication of these data is that in public education programs specific messages should be aimed at those subgroups that show the poorest levels of self-surveillance.

The Current Management and Prognosis of Acral Lentiginous Melanoma

A computer-aided retrospective analysis was performed on 359 patients with stage I and II melanoma at the time of diagnosis (disease confined to the primary melanoma), at the University of South Florida (Tampa, FL). Eighteen patients were identified with primary melanoma in acral locations, most being acral lentiginous melanoma. A comparison of actuarial survival curves of patients with melanoma in four different locations (acral, head and neck, trunk, and other extremity site) was performed. The patients with melanoma in acral locations did not have a statistically different actuarial survival than those with primary melanoma in other sites. When actuarial disease-free survival curves were constructed, however, acral primary melanoma had a shorter interval to recurrence than those located on the trunk or other extremity sites. Differences between actuarial disease-free survival for the head and neck and for acral primary sites were not significant. To identify prognostic factors responsible for the decreased disease-free survival of the acral lentiginous population, a regression analysis was performed. Three prognostic factors were analyzed for stage I and II melanoma, including Breslow tumor thickness, ulceration of the primary lesion, and primary site location. In the univariate analysis, with each prognostic factor acting independently, tumor thickness (p less than 0.01) and ulceration (p = 0.02) were significant variables influencing the disease-free interval. Primary site did not, however, add prognostic information to the model (p = 0.54). A stepwise multivariate analysis confirmed this finding.

Breslow thickness of cutaneous malignant melanoma in paraffin wax and frozen sections.

Breslow tumour thickness was measured in frozen and paraffin wax sections from 21 excision biopsies of cutaneous malignant melanomas by two observers. There was no consistent variation between frozen and paraffin wax sections, with recorded differences ranging from +0.3 mm to -0.2 mm. Interobserver differences ranged from +0.4 mm to -0.2 mm. The interobserver variations exceeded the intraobserver variations, but neither were significant. These findings show conclusively that, when using high quality frozen sections, there is no significant difference between Breslow thickness measured in frozen or paraffin wax sections and therefore that frozen sections can be used to microstage melanoma. Interobserver variations seem to be a more likely source of erroneous measurements of tumour thickness.

Vascularity in cutaneous melanoma detected by Doppler sonography and histology: Correlation with tumour behaviour

The blood flow in 71 primary skin melanomas was investigated by a 10MHz Doppler ultrasound flowmeter and flow signals were analysed on an Angioscan-II spectrum analyser. Doppler flow signals were detected in 44 tumours, with a close relationship to Breslow's tumour thickness. No blood flow signal was detected in 27 lesions and 25 of these had a tumour thickness of 0.8 mm or less. Ninety-seven per cent of tumours of thickness greater than 0.8 mm had detectable Doppler flow signals. Histological assessment of vascularity by Ulex europaeus agglutinin 1 lectin staining showed a high vascularity at the tumour base of Doppler positive lesions. The vascularity quantified by measurement on an IBAS-2 image analyser correlated well with the blood flow demonstrated by Doppler ultrasound. This study indicates the development of a neovascular bed as the tumour thickness approaches 0.8 mm. Doppler signal analysis revealed higher peak and mean systolic frequencies over melanomas associated with regional or systemic spread than flow signals from melanomas of patients remaining disease-free for 2 years.