Survival and Prognostic Factors in Patients with Malignant Melanoma: Statistical Analysis of 466 Cases Treated between 1998 and 2014

Abstract

The aim of this study is to analyse how patient's or melanoma's characteristics influence the prognosis. Therefore, we retrospectively reviewed and analysed our database, selecting 466 patients with most complete data. At diagnosis, average age is 55 years; most melanomas are in stage Ib, mean thickness amounts to 2.14 mm, with gradual reduction over the time. Ulceration is detected in 24% of cases, being associated with augmented thickness and reduced survival. Mostly, the number of mitosis per mm 2 is >1 and nodal infiltration is present in mild form. Women have more frequently primitive melanomas of the limbs; men often develop primitives on the trunk. In the head and neck district we find the highest percentages of advanced nodular melanomas. The sentinel node is positive in about 20% of cases. Elderly patients, despite lower lymphatic involvement rates, show worst prognosis. Univariate estimates on the likelihood to have positive SNs linked to individual prognostic factors demonstrate the importance of high thickness, nodular type, advanced age, presence of ulceration and absence of regression. Mean number of excised nodes during CLND is around 17. At deadline, mortality is 13.48%, overall survival at 1, 3 and 5 years is 99, 93 and 88% respectively. Survival improved among time (88 vs. 95% at 3 years, 83% vs. 90% at 5 years). Analysis of survival indicates advanced stage at diagnosis, high thickness, nodular type, head and neck location, male sex and advanced age as negative prognostic factors. The presence and quality of nodal involvement strongly affects survival: Positive nodal biopsy patients show 30% lower OS5y values, mostly in case of macroscopic tumor burden.