Malignant melanoma of the skin: prognostic value of histology in 89 cases

Abstract

THE histological features which distinguish a malignant melanoma from a benign naevus cell tumour include the following: active, atypical, irregular naevus cell proliferation at, and with destruction of, epidermal-dermal junction, invasion of dermis and epidermis often with ulceration, disorderly cell distribution with loss of naevus nest pattern, frequency of mitoses, nuclear hyperchromasia and cellular pleomorphism; melanin pigment though sometimes increased may be absent.There is a wide variation in the reported 5 year survival of patients with malignant melanomas, ranging from 05 Y% (Bloodgood, 1922) The histological features were defined as follows, omitting those which are self explanatory. Polypoid growth includes lesions protruding above the general skin surface, whether with a smooth or papillary outline. Epidermal hyperplasia refers to squamous and basal cell proliferation at the edges of or over a lesion and is graded as absent or minimal, 0-1; moderate-marked, 2-3. Depth of spread is related to the position of sweat glands and the lesion may be superficial or deep.Cell morphology is divided into epithelial or spindle and best assessed in cells adjacent to vessels, so allowing for plane of sectioning. The proportion of epithellal and spindle cells were graded: 0-absent, 1-less than 33 %, 2-more than 33 % but less than 66 % and 3-more than 66 % per high power field. Naevoid

Mitotic Rate in Cutaneous Melanomas ≤1 mm in Thickness

“…Melanomas with significantly elevated MRs have been shown to be associated with a poor prognosis for more than 30 years 6,7 ; however, more recent studies have attempted to use MR to predict SLN positivity. Several early studies were unable to show any predictive value 8,9 but recent larger studies have suggested that MR may be predictive of SNL positivity and may be an important independent prognostic factor.…”

Eosinophilic Cytoplasmic Inclusion Bodies in Vesicular Multinucleated Melanocytes

“…4 In this study, these cells were present in 85% of lentigo maligna cases in contrast to 21% of control cases in which skin excisions were done for basal cell and squamous cell carcinomas. Other types of multinucleated melanocytes have also been described in melanomas, 8 however, these cells did not seem to have any significant implications for diagnosis or prognosis. In our experience, the vesicular multinucleated melanocytes containing cytoplasmic eosinophilic inclusion bodies described here are a relatively common finding and are invariably seen in long-standing compound or intradermal melanocytic nevi and most often FIGURE 1.…”

Epithelial cell kinetics. A review of methods of study and their application to oral mucosa in health and disease

“…In malignant melanoma the MI varies considerably among patients and has been reported to be an important prognostie indicator, i.e., a low mitotie count indicating better prognosis, by Williams et al (1968), Coehran (1969), Larsen & Grude (1978a) and Sehmoeckel & Braun-Faleo (1978) but not by Huvos et al (1974). As the 5 year survival rate for melanoma of the skin is relatively low eompared with that for other malignant neoplasms (Cancer Statistics 1979), recognition of those faetors which are most important in identifying patients with poor prognosis eould be particularly useful in selecting those with tumours at early stages for whom additional therapy might be recommended.…”