Development and Initial Validation of Calculated Tumor Area as a Prognostic Tool in Cutaneous Malignant Melanoma

Abstract

IMPORTANCE Breslow thickness is a 1-dimensional surrogate prognostic feature for tumor size, yet tissue sections have 2 dimensions. Therefore, a 2-dimensional feature, calculated tumor area (CTA), was devised. OBJECTIVE To determine CTA precision and prognostic value.

Comparison of the prognostic value of microscopically measured invasive width versus macroscopic width in cutaneous melanoma shows the superiority of microscopic invasive width measurement

“…In a further iteration of this general theme, an improved metric was devised, namely the total area occupied by invasive melanoma cells on the same histopathology slide where the BT measurement was made. Known as the calculated tumor area (CTA), this was found to be a better prognostic feature than both BT and BD 5 . A drawback of CTA was that it entailed the use of a subjective estimated value.…”

“…Known as the calculated tumor area (CTA), this was found to be a better prognostic feature than both BT and BD. 5 A drawback of CTA was that it entailed the use of a subjective estimated value. To circumvent this, we assessed the use of a feature that could be measured objectively, namely the width of the area containing invasive melanoma cells.…”

Ultrasound-Mediated Microbubble Destruction Inhibits Skin Melanoma Growth by Affecting YAP1 Translation Using Ribosome Imprinting Sequencing

“…Cutaneous melanoma (CMM) is a skin tumor with a high degree of malignancy and rising incidence ( 1 , 2 ), with a larger tumor volume positively correlating with an increased prognostic risk of patients ( 3 ). Thus, in the related field, exploring the mechanisms underlying the occurrence and development CMM have become a main research direction for improve CMM patients’ prognosis.…”

The Second Dimension—Integrating Calculated Tumor Area Into Cancer Diagnosis

“…Prior investigators have attempted to improve on Breslow thickness as a staging parameter, without gaining traction . In this issue of JAMA Dermatology , Saldanha et al continue this effort with their proposal of calculated tumor area (CTA) as a prognostic determinant. The CTA adds a second dimension, relying on tumor area rather than simply thickness, and thus it more accurately parallels true tumor volume and prognosis.…”

“…Very thin melanomas with a broad zone of invasion often have greater tumor volume than thicker tumors with limited dermal involvement. In the validation data set that Saldanha et al used, CTA was superior to conventional staging in accurately conveying prognosis in the context of what might be termed prominently invasive T1 melanomas and minimally invasive T2 melanomas. One beauty in the application of CTA is its utter simplicity, because the assessment can be completed in a timely fashion using conventional histopathologic sections.…”