Survival with primary cutaneous malignant melanoma, evaluated from 2012 cases

Abstract

Cox's multivariate regression model for survival data was applied to 2,012 patients with primary cutaneous melanoma in order to evaluate the relative prognostic value of numerous clinical and histological variables and to establish their prognostically most efficient combination. The material was divided into 4 groups according to the size of resection margin of the primary lesion (less than 2.0 cm, 2.0 cm, 2.1-4.9 cm, and greater than or equal to 5.0 cm). Data were analysed separately in these 4 groups and equivalent results were obtained. The risk factors were clinical stage, site of tumour, tumour thickness, level of invasion, mitotic activity, ulceration, lymphocytic reaction, predominant type of invasive tumour cell and partial regression. When accounting for these factors, histological type, nuclear pleomorphism, nucleolar size, vascular invasion, pigmentation, verrucous growth pattern, and dermal elastosis were without prognostic influence. The effect of sex and age of patient was uncertain and both variables, therefore, were retained in the model. By using Cox's method it is possible to make a qualified estimate of the survival for the individual patient.

The relationship between risk of death from clinical stage 1 cutaneous melanoma and thickness of primary tumour: no evidence for steps in risk

“…It has consistently been shown in multivariate analyses from different countries that the thickness of the primary tumour, measured from the granular cell layer of the epidermis to the deepest malignant cell, is the most important independent predictor of survival from clinical Stage cutaneous malignant melanoma (Balch et al, 1978;Sondergaard et al, 1985;Bonett et al, 1986;Meyskens et al, 1988).…”

Prognosticators of melanoma, the melanoma report, and the sentinel lymph node

“…3,6,10,11,[46][47][48][49][50][51][52][53][54] The Breslow measurement is taken from the epidermal surface or, in the event that the surface is ulcerated, from the base of the ulcer, and is made with a calibrated ocular micrometer. 3 Long clinical follow-up indicates that melanoma thickness is a continuous variable associated with dropout of survivors beyond 10 years.…”

Classification of cutaneous malignant melanoma

“…35 It took almost 20 years to appreciate that the subtypes do not differ from one another prognostically if the thickness is taken into account. [7][8][9][10][11] With regard to research, numerous studies were conducted in search of evidence for fundamental biologic differences between the types of melanoma. The cells of invasive nodules of LMM were said differ ultrastructurally from those of SSM and NM.…”

“…However, numerous studies have failed to reveal differences in prognosis of the four major types if the thickness of lesions is taken into account. [7][8][9][10][11] Some authors have denied the existence of principal differences between the subtypes and have suggested discarding the current classification of malignant melanoma. 12,13 The main point of criticism is the lack of agreed upon criteria for recognition of the four major types: Different criteria have been employed by different authors and even by the same authors at different times.…”