An observational study regarding the rate of growth in vertical and radial growth phase superficial spreading melanomas

Abstract

Abstract. The natural history of superficial spreading melanomas (SSMs) involves the progression from a radial growth phase (RGP) to a vertical growth phase (VGP). Currently, a patient's history represents the only method to estimate the rate of tumor growth. The present study aimed to verify whether the estimated rate of growth (ROG) of SSMs with a RGP or VGP exhibited any differences, and to evaluate the possible implications for the most important prognostic determinants. ROG was quantified as the ratio between Breslow's thickness in millimeters (mm) and the time of tumor growth in months, defined as the time between the date that the patient had first noticed the lesion in which melanoma subsequently developed and the date on which the patient first felt this lesion changed. A total of 105 patients (58 male and 47 female) were studied. Of these, 66 had VGP-SSMs, whilst 39 had RGP-only SSMs (RGP-SSMs). No significant differences in age and gender were observed between these groups. The mean Breslow's thickness in patients with VGP-SSMs was significantly greater than in patients with RGP-SSMs (0.78±0.68 vs. 0.48±0.22 mm, P=0.0096). Similarly, the ROG was observed to be higher in VGP-SSM vs. RGP-SSM patients (0.13±0.16 vs. 0.065±0.09 mm/month, P=0.0244). In patients with VGP-SSMs, Breslow's thickness and ROG were significantly higher for tumors with a mitotic rate of ≥1 mitosis/mm 2 compared with those with <1 mitosis/mm 2 (1.15±0.96 vs. 0.56±0.30 mm, P=0.0005; and 0.188±0.20 vs. 0.09±0.12 mm/month, P=0.0228, respectively). According to these results, two subsets of SSMs exist: The first is characterized by the presence of mitosis and a higher ROG, while the second exhibits a more indolent behavior and is characterized by an RGP only. Given the differences in the Breslow's thickness and ROG, clinicians must be aware of the possible diagnostic delay in these subsets of melanoma that, differently from true nodular melanomas, generally fulfill the classical ABCD clinical criteria. IntroductionSuperficial spreading melanoma (SSM) and nodular melanoma (NM) exhibit different growth patterns, being characterized by slower and faster growth, respectively. The radial growth phase (RGP), which is present in SSM and absent in NM, is of paramount importance in the classification of melanoma (1-3). The rapid growth of primary melanomas is associated with aggressive features and a negative effect on prognosis (4). According to the linear model of progression, malignant melanocytes in SSM spread radially prior to invading vertically. Clark et al (1) designated this invasion pattern the vertical growth phase (VGP), and defined it as the focal formation of a dermal nodule within the RGP. Melanomas with a VGP do not necessarily indicate NM.Patient interviews are a useful source of information about the growth phase of the tumor (5). The rate of growth (ROG), which is defined as the ratio between Breslow's thickness in millimetres and the duration of tumor growth in months, currently represents the only method to measure the grow...

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