Prognostic index for malignant melanoma

Abstract

This report verifies the ability of a Prognostic Index (PI) to accurately predict 5-year survival rates for 879 Stage I cutaneous malignant melanoma (MM) patients seen at New York University Medical Center. The PI used in this study was first reported from Munich, West Germany, and is calculated from standard histologic sections by multiplying the MM thickness in millimeters (Breslow method) by the number of MM mitoses per square millimeter. A PI value of less than 19 versus greater than or equal to 19 was found to be a significant and independent prognostic variable for Stage I MM when compared with seven other predictive variables (including Breslow thickness). These PI intervals identified a subgroup of patients with MM of intermediate thicknesses (1.50-3.49 mm) whose significantly worse survival would not have been anticipated if prognosis were determined by Breslow thickness alone. For example, patients with MM 1.50 to 2.49 mm thick have a 5-year survival rate of 84.1% determined by Breslow thickness alone; however, among these patients exists a subgroup with PI greater than or equal to 19 whose survival rate is only 57.6%. This study verifies the additive usefulness of the PI in predicting survival rates of patients with Stage I cutaneous MM.

Clinicopathological characteristics at primary melanoma diagnosis as risk factors for brain metastasis

“…Our study cohorts were comprised of prospectively-accrued, cutaneous melanoma patients at New York University Medical Center, enrolled in either the Melanoma Cooperative Group (MCG) (November 1972–November 1982) [12] or the Interdisciplinary Melanoma Cooperative Group (IMCG) (August 2002–December 2009) [13]. 18 patients were accrued at Bellevue Hospital, while the remaining patients were accrued at NYU Clinical Cancer Center.…”

Molecular diagnostics in melanoma

“…[159][160][161] In the progression from primary to metastatic melanoma, the clinical tumor doubling time increases, and primary melanoma's tumor mitotic rate significantly correlates with decreasing survival. [123][124][125]133,[162][163][164][165][166][167] Ki-67 (ie, MIB-1) index, proliferating nuclear antigen index, S-phase fraction, and silver-stained nuclear organizing region counts all are reliable and widely used methods of measuring proliferative index (growth fraction), 168 and have been shown to be independent prognostic factors in small melanoma cohorts. [139][140][141][142] Moreover, cell-cycle regulators such as cyclins A and D3, p27 Kip1 , and p16 INK4 correlate with proliferative index markers and independently predict for prognosis in subsets of patients with melanoma (eg poor prognosis for cyclin D3 index [ 5% in superficial spreading melanoma).…”

Prognostic signs in melanoma: state of the art

“…Koph et al 12 have reported survival rates of 23% and 85% with Pi (mitotic index × melanoma thickness) values of > 18 and < 18, respectively.…”