Malignant melanoma patients with positive nodes and relatively good prognoses: Microstaging retains prognostic significance in clinical stage I melanoma patients with metastases to regional nodes

Abstract

Fifteen variables were tested for their value in predicting recurrent disease in 46 clinical Stage I melanoma patients with metastases to regional nodes. A stepwise proportional hazards general linear model (Cox multivariate analysis) separated these melanoma patients with regional node metastases into at least two risk groups. Twenty patients in the relatively low-risk group had a five-year disease-free survival of 80% (in spite of having nodal metastases). This compares to a five-year disease-free survival of 17.5% for 26 patients in the high-risk group (P less than 0.001, Lee-Desu Statistic). Criteria for the high-risk group required that a patient have only one of the following two values: (1) The number of regional lymph nodes that contained tumor divided by the total number of nodes removed x 100% (percentage of positive nodes) greater than or equal to 20%; or (2) a primary tumor thickness of greater than 3.5 mm (regardless of node percentage). Conversely, patients in the low-risk group had neither of the above features. The high-risk group could further be stratified by the lymphocytic response at the base of the tumor. These findings have direct immediate application to the elective regional node dissection controversy and to adjuvant therapy studies containing these patients.

Cutaneous melanoma: estimating survival and recurrence risk based on histopathologic features

“…Microstaging of primary tumors by standard techniques retains some predictive power when applied to patients with regional lymph node metastases, in whom there are subsets with favorable survival (4–6). However, microstaging is most effective when applied to patients with localized tumors in whom the clinically apparent disease is confined to the local site.…”

“…Characteristics of the primary tumor retain some significance in some subsets of patients with regional lymph node metastases, particularly when the extent of nodal disease is limited, for example to less than 20% of the total nodes removed according to the study of Day et al. (4). The number of involved lymph nodes is highly predictive of prognosis.…”

Immune and gene therapy for melanoma, and the immunobiology of melanoma

“… 17–20 Within stage III patients, 5‐year survival rates have an inverse correlation with the number of positive lymph nodes (42–58% for one node and 10–18% for five nodes), and differ between microscopic and macroscopic nodal involvement (differing by 17–25%). 16–20 The majority of chemotherapy trials have been disappointing, and there have been no real significant advances in survival data with chemotherapy. 5 , 18 Thus, adjuvant MM therapy is now focusing on immunotherapy.…”

Malignant Melanoma Prognostic Factors 5: Clinical Staging

“…In contrast to the almost uniformly dismal prognosis for clinical stage II, pathologic stage II patients, those with clinical stage I, pathologic stage II disease fare much better. The Melanoma Clinical Cooperative Group at the Massachusetts General Hospital and New York University Medical Center 4 [MGH‐NYU MCCG], in a review of 24 studies of clinical stage I, pathologic stage II patients, found that their mean survival was 45%.…”