Prognostic index in malignant melanoma

Abstract

A retrospective study was undertaken of 146 surgically treated subjects with primary cutaneous melanoma of which 73 were disease-free for five to nine years and 73 developed later metastases. A prognostic factor was south to determine patients with poor prognoses. The best overall method was shown to be the evaluation of the prognostic index defined as the product of tumor thickness and the number of mitoses per square millimeter. However, for establishing a group of patients with no incidence of metastases, the mitotic rate proved to be as good a factor as the prognostic index and better than tumor thickness or levels of invasion. The application of this prognostic index seems therefore to be useful in selecting for further treatment stage I melanoma patients with poor prognoses, eg, prophylatic lymph node dissection and immunochemotherapy.

A clinicopathologic review of lethal nonmelanoma skin cancers in Western Australia

“…We measured thickness from the top of the neoplasm rather than the top of the granular layer of epidermis to avoid overestimation of measured neoplasm thickness as recommended by other investigators. 12 In North America level of invasion is commonly reported rather than neoplasm thickness for SCC. 32 In this study, we measured level of invasion as used for malignant melanoma 12,13 and by other investigators for SCC.…”

“…12 In North America level of invasion is commonly reported rather than neoplasm thickness for SCC. 32 In this study, we measured level of invasion as used for malignant melanoma 12,13 and by other investigators for SCC. 35,36 Most lethal neoplasms invaded to the subcutis (level 5), 3 of 35 had invaded the reticular dermis, and no level 3 neoplasms resulted in metastasis and death.…”

“…The distance was measured using an optical micrometer and spanned from the uppermost to the lowest neoplastic cell as used previously for melanoma. 12 This method differs from that recommended by Breslow 13 in that the overlying epidermis was not included. The basis for this is that only the invasive component of the neoplasm produces metastasis, and inclusion of the overlying epidermis, often greatly thickened, would produce a falsely high measurement.…”

Tumor angiogenesis as a prognostic factor in thick cutaneous malignant melanoma

“…The patients' charts were analyzed for age at diagnosis, sex, and location of the tumor. Histopathological slides were reviewed for the following parameters: histological type and level of invasion, respectively, assigned and categorized according to the guidelines of Clark et al [7]; tumor thickness, determined according to the method suggested by Breslow [4]; histological regression, presence of ulceration, vascular invasion, presence of microscopic satellites, tumor invasive front (labeled as pushing or infiltrating) [15], and mitotic rate/mm 2 , determined by the method of Schmoeckel and Braun-Falco [19] and using the cut-off values proposed by Clark et al [8].…”

The Magic of Numbers: Malignant Melanoma Between Science and Pseudoscience

“…That a high mitotic rate has an adverse impact on prognosis has been known for more than 30 years. [22][23][24] Recently, that finding has been rediscovered, with several studies demonstrating an independent prognostic influence in thin and advanced melanomas. [25][26][27][28][29] In thin melanomas, even a single mitotic figure was said to impair prognosis significantly.…”