Thin cutaneous malignant melanomas (≤1.5 mm) : Identification of risk factors indicative of progression
✍ Scribed by Daniela Massi; Alessandro Franchi; Lorenzo Borgognoni; Umberto Maria Reali; Marco Santucci
- Publisher
- John Wiley and Sons
- Year
- 1999
- Tongue
- English
- Weight
- 217 KB
- Volume
- 85
- Category
- Article
- ISSN
- 0008-543X
No coin nor oath required. For personal study only.
✦ Synopsis
Background:
Although thin cutaneous melanomas generally have a favorable prognosis, in some cases they may undergo progression. the current study was undertaken to identify variables that may predict a more aggressive clinical outcome in these patients. in addition to classic clinicopathologic features, the authors tested the prognostic impact of three new morphometric quantitative parameters: 1) tumor thickness plus regression thickness (t+r), 2) percentage of skin thickness infiltrated by tumor cells (t/s ratio), and 3) percentage of skin thickness infiltrated by tumor cells and regression ([t+r]/s ratio).
Methods:
The authors retrospectively evaluated 287 patients with invasive cutaneous melanoma < or = 1.5 mm in thickness. disease free survival rates (kaplan-meier method) were compared by using the log rank test. a multivariate analysis (cox proportional hazards model) was used to determine the independent effect of each variable on progression. progression was defined as any documented cutaneous local and/or distant metastasis.
Results:
Thirty-two of the 287 patients (11.1%) underwent disease progression. the overall 5-year and 10-year disease free survival rates were 89.3% and 84.6%, respectively. in the univariate analysis, the following factors were found to be significant predictors of progression: male gender (p = 0.01), acral-lentiginous histotype (p = 0.02), tumor thickness (p = 0.005), t+r (p = 0.001), t/s ratio > or = 50% (p = 0.03), (t+r)/s ratio > or = 50% (p = 0.006), vertical growth phase (p = 0.04), and absence of inflammatory response (p < 0.0001). conversely, age, site, and clark's level did not affect the risk of recurrences and/or metastases significantly. in the multivariate analysis, only t+r (p = 0.009) and inflammatory response (p < 0.0001) were found to be independent predictors of progression. five-year disease free survival rates according to presence versus absence of inflammatory response were 93.4% and 63.8%, respectively (p < 0.0001).
Conclusions:
In the current study, peritumoral and intratumoral inflammatory infiltrate and t+r were found to be strong independent predictors of progression in thin cutaneous melanomas.