Primary Cutaneous Melanoma: An 18-Year Study

Abstract

BACKGROUND:Primary cutaneous melanoma still constitutes the main cause of skin cancer death in developed countries, and its incidence in recent years has been increasing in a steady, worrisome manner.OBJECTIVES:This study evaluated the clinical, epidemiological and demographic aspects of this disease, and correlated them with patient prognosis.METHODS:Using epidemiologic and clinical data, we analyzed 84 patients with mild to severe primary cutaneous melanoma treated between 1990 and 2007. Slides containing surgical specimens were analyzed, and new slides were made from archived paraffin sections when necessary.RESULTS:The melanoma incidence was higher in areas of sun exposure, with lesions commonly observed in the trunk for males, and lower limbs for females. In addition to Breslow’s thickness and ulceration (p = 0.043 and p < 0.001, respectively), the mitotic rate per mm2 also correlated with worse patient outcome (p = 0.0007). The sum of ulceration (0 when absent or 1 when present), the Breslow index (1 when <1 mm, 2 when >1 mm and <4 mm, 3 when >4 mm) and the mitotic index (0 when absent or 1 when ≥1 per mm2) allowed the establishment of a prognostic score: if the sum was equal to or over three, nearly all (91.7%) patients had systemic disease. The 5-year survival was approximately seventy percent.CONCLUSION:Because American Join Committee of Cancer Staging will update the classification of malignant tumors (TNM) staging in the near future, and introduce mitosis as a prognostic factor, our results show the importance of such a feature. Additional studies are necessary to confirm the importance of a prognostic score as proposed herein.

Association between Patient’s Basic Characteristic and Clark Level in Cutaneous Malignant Melanoma

“…More than half of malignant melanoma cases in this study occurred in female, it is similar with Anger et al 9 in Brazil. In the study by Markovic et al 4 it is noted that the increasing of malignant melanoma cases in women Egie Rahmalaelani, Hermin Aminah Usman, Jono Hadi Agusni: Association between Patient's Basic Characteristic and Clark Level in Cutaneous Malignant Melanoma occurred due to the use of oral contraception (estrogen and progesterone) that can stimulate the proliferation of melanocytes and as well as the lifestyle changes, such as how to dress up daily.…”

“…3 In this study, the association between age and Clark level showed non significant (p=0.679). This is similar with Anger et al 9 who mentioned that age does not affect the level of malignant melanoma invasion.…”

“…12 In this study, the significant result showed (p=0.023) on the association between the location of the lesion and Clark level. This result was similar with Anger et al 9 Noncephalic/acral locations such as the palms and soles that have thicker skin than other parts of the body skin, they should have a slower level of invasion. Acral melanoma becomes invasive when the melanoma cells cross the basement membrane of the epidermis and malignant cells enter the dermis.…”

Expression of cyclins A and E in melanocytic skin lesions and its correlation with some clinicopathologic features

“…Of these, the most important for primary tumors are tumor thickness (Breslow scale), mitotic rate and the presence of ulceration or regression. In problematic cases, these parameters are not always sufficient and additional data is needed to clarify the prognosis [43,44,47].…”

“…The mitotic rate (MR) was estimated in a 1-mm ˛area, by beginning in the field with the highest numbers of mitoses and then by counting in subsequent nonoverlapping fields, as recommended by the 1982 Pathology Workshop [41,42]. Due to the heterogeneity of our melanoma group (regarding differences in the number of mitotic figures per 1 mm˛ between cases) we decided to code MR as 0 -no mitoses or 1 -mitoses present [43].…”