Clinicopathologic prognostic markers of survival: an analysis of 259 patients with malignant melanoma ≥1 mm

Abstract

The histopathologic status of the sentinel node (SN) and the ulceration of the primary tumor are important indicators of the clinical outcome of melanoma patients. The purpose of this study was to investigate potential correlations between prognostic factors and the sentinel lymph node status as well as their influence on disease-free survival (DFS), distant metastases-free survival (DMFS), and overall survival (OS). The medical records of 259 melanoma patients who underwent sentinel lymph node dissection between 2000 and 2006 were analyzed. DFS, DMFS, and OS were assessed. A uni- and a multivariate analysis to determine prognostic factors were performed. Histologic type, Clark's level, and Breslow's tumor thickness were the only parameters that showed a significant correlation with a positive SN. The univariate analysis revealed SN positivity (DFS and DMFS: p < 0.001; OS: p = 0.039) and ulceration (DFS: p < 0.001; DMFS: p = 0.001; OS: p = 0.003) to be significant prognostic markers. However, ulceration was the only independent prognostic factor for OS that was upheld by the multivariate analysis (p = 0.006; HR 3.89; CI 1.48-10.27). In stage I/II melanoma patients, ulceration of the primary tumor was the strongest prognostic factor for RFS, DMFS, and OS and superior to the pathology status of the SN.

Is primary melanoma ulceration a factor of good response to adoptive immunotherapy?

“…Our results, in accordance with the usual data from the literature, 9,14–17,33 confirm the pejorative factor of primary melanoma ulceration for relapse‐free survival and overall survival in our patients treated with TIL adoptive immunotherapy in an adjuvant setting after lymph node resection. Besides, the test for interaction does not find any improvement in the response to TIL treatment in the presence of ulceration.…”

“…Some independent prognostic factors have been defined in relation to the different stages of melanoma. At primary tumour stage, 8–13 these factors are the Breslow index, ulceration 9,14–17 and the mitotic index 14–16 . At the regional stage, 8–10 these are the number of metastatic lymph nodes, the nodal tumour burden (microscopic vs. macroscopic) and some histological characteristics of the primary melanoma (Breslow index and ulceration).…”

Prognostic significance of drainage to pelvic nodes at sentinel lymph node mapping in patients with extremity melanoma

“…As others have reported previously, we found that age [15], sex [16], anatomic site [17], MR [18], ulceration [10,19,20], lymphovascular invasion [21,22], satellitosis [23,24], Breslow's depth [10,19,23], and SLN status [1,[25][26][27](data not shown) were associated with TTR by univariate analysis. As others have reported previously, we found that age [15], sex [16], anatomic site [17], MR [18], ulceration [10,19,20], lymphovascular invasion [21,22], satellitosis [23,24], Breslow's depth [10,19,23], and SLN status [1,[25][26][27](data not shown) were associated with TTR by univariate analysis.…”

Varying Mutational Alterations in Multiple Primary Melanomas

“…Both parameters are well-known negative prognosticators of patients' outcomes. 31,32 Interestingly, OS was also significantly associated with the number of melanomas per patient: Patients with three or more primary melanomas had a significantly greater overall survival than did patients with two melanomas, although the number of patients in the subgroup with 3 or more primary melanomas was low. Improved survival in MPM patients compared with those with single primary melanomas was described in the analysis by Ferrone et al 2 in 4484 melanoma patients.…”