Problems in the measurement of tumor thickness and level of invasion in cutaneous melanoma

1977 ◽  
Vol 8 (1) ◽  
pp. 1-2 ◽  
Author(s):  
Alexander Breslow
Keyword(s):  
Cutaneous Melanoma ◽  
Tumor Thickness ◽  
Level Of Invasion

scholarly journals Does morphology have real impact on local and distant recurrences in head and neck cutaneous melanoma?

2020 ◽  
Vol 10 (3) ◽  
pp. 55-64
Author(s):  
A. M. Mudunov ◽  
M. B. Pak ◽  
L. V. Demidov ◽  
K. A. Baryshnikov
Keyword(s):  
Prognostic Factors ◽  
Surgical Treatment ◽  
Local Recurrence ◽  
Head And Neck ◽  
Cutaneous Melanoma ◽  
Primary Tumor ◽  
Resection Margin ◽  
Tumor Thickness ◽  
Treatment Results ◽  
Level Of Invasion

Introduction. The term “local recurrence” is usually understood as regrowth of a tumor after surgical treatment. The regrowth appears within 3–5 cm from postoperative cicatrix. The causes for such prolonged tumor growth or recurrence of patients with cutaneous melanoma are nonradical surgical treatment as well as satellite or transit metastases that were not removed in-block with primary tumor. A great number of clinical researches, aimed at examination of melanoma, its patterns, anatomical criteria and features of clinical course, gave an opportunity to separate satellite or transit metastases into an independent group. Such metastases are realized inside or subdermally, up to 2 cm or more than 2 cm from the primary tumor, yet, not reaching the location of the first regional barrier.The aim of the study is to define influence of the main prognostic factors such as tumor thickness according to Breslow, the level of invasion according to Clark and the presence of ulceration on the frequency of local recurrence with cutaneous melanoma of head and neck.Materials and methods. The research involved 174 patients with cutaneous melanoma of head and neck (1995–2014). According to our index of contraction of a skin flap (median 30 %) the true borders of resection were clearly defined within all the patients. Thereby, 3 groups were identified with the following resection margin: 1.0 cm, where followed-up treatment results were analyzed.Results. Progression-free survival didn’t correlate with the size of surgical resection margins. The survival rates were the best with the lowest resection margin under 0.5 cm (77.3 %) and the worst with the highest resection margin more then 1.0 cm (38.7 %). That means that the treatment results don’t depend on the width increase of tumor resection margin.Conclusions. We consider that clear surgical margins for any thickness of cutaneous melanoma of head and neck should be as follows: 4 mm – 0.72 mm (p = 0.016). In our work, the influence of the main prognostic factors, such as tumor thickness according to Breslow, level of invasion according to Clark and ulceration on the frequency of head and neck cutaneous melanoma local recurrences had no impact.

Critical analysis of the current American Joint Committee on Cancer staging system for cutaneous melanoma and proposal of a new staging system.

1997 ◽  
Vol 15 (3) ◽  
pp. 1039-1051 ◽  
Author(s):  
A C Buzaid ◽  
M I Ross ◽  
C M Balch ◽  
S Soong ◽  
W H McCarthy ◽  
...  
Keyword(s):  
Cutaneous Melanoma ◽  
Staging System ◽  
Tumor Thickness ◽  
Published Data ◽  
Nodal Metastases ◽  
Level Of Invasion ◽  
American Joint Committee ◽  
Ajcc Staging System ◽  
Ajcc Staging ◽  
The Impact

PURPOSE To critically review the accuracy of the current American Joint Committee on Cancer (AJCC) staging system for cutaneous melanoma and propose a more useful staging system. METHODS Retrospective evaluation of the published data as well as a reanalysis of the University of Alabama and Sydney Melanoma Unit (UAB/SMU) data bases (n = 4,568) for patients with primary melanoma was performed to examine specifically the impact of level of invasion and ulceration on the prognostic value of tumor thickness. In addition, an overlay graphic technique was used to compare the Kaplan-Meier survival curves of patients with local recurrences, satellites, in-transit metastases, and nodal metastases reported in the literature. RESULTS Tumor thickness and ulceration remained the most powerful prognostic indicators in patients with stage I and II disease. Level of invasion provided statistically significant prognostic information only in the subgroup of patients with tumor thickness < or = 1 mm, but the absolute 10-year survival differences were small and inconsistent (level II, 95%; level III, 85%; level IV, 89%). The best statistical fit for tumor thickness cutoffs was at 1 versus 2 versus 4 mm. The overlay graphic technique showed that patients who developed satellite lesions or local recurrence had prognoses similar to those of patients with stage III disease. The most important prognostic factor for patients with nodal metastases was number of involved nodes rather than size. CONCLUSION Our analysis showed that the current AJCC staging system has many inaccuracies that should be modified to conform to published data. On the basis of our analysis and review of the literature, we propose a new and more accurate staging system.

Trends in Invasive Cutaneous Melanoma in Saskatchewan 1970–1999

2003 ◽  
Vol 7 (6) ◽  
pp. 433-442 ◽  
Author(s):  
Marcie J. Ulmer ◽  
Jon M. Tonita ◽  
Peter R. Hull
Keyword(s):  
Prognostic Factors ◽  
Cutaneous Melanoma ◽  
Excess Mortality ◽  
Tumor Thickness ◽  
Tumor Characteristics ◽  
Anatomic Site ◽  
Clark Level ◽  
Melanoma Incidence ◽  
Number Of Patients ◽  
And Gender

Background: Melanoma incidence rates have increased dramatically in white populations worldwide during the past several decades. A more modest increase has been observed for melanoma-related mortality. Cause-specific and disease-free survivals are related to tumor characteristics, gender, age, and possibly anatomic site. It is difficult to accurately assess these trends without information on tumor thickness that is often unavailable. Objective: This study determines trends in melanoma incidence, mortality, and survival in Saskatchewan for a 30-year period, incorporating analysis of tumor thickness. Methods: Information about cases of primary cutaneous melanoma for the 30-year period 1970–1999 was obtained from the population-based Saskatchewan Cancer Registry. A 50% random sample of charts was reviewed to collect information about Breslow depth, Clark level, and other demographic data not available from the Registry. Multivariate regression analysis was used to determine the significance of prognostic factors on incidence and five-year relative survival rates. Results: The number of patients registered increased dramatically during the study period. The increase was greatest for thin lesions in all age groups. Anatomic site varied by gender. Head and neck tumors showed continual increase in risk with increasing age. Mortality rates in females have been stable over time but increased for males in the 1990s. The prognostic factors that predicted excess mortality at five years were tumor thickness, Clark level, and gender. Conclusion: The observed increase in melanoma appears to be real and not the result of increased surveillance or screening. Tumor characteristics (Breslow depth, Clark level) and gender were significant prognostic indicators of five-year excess mortality.

Tumor-Infiltrating Lymphocyte Grade Is an Independent Predictor of Sentinel Lymph Node Status and Survival in Patients With Cutaneous Melanoma

2012 ◽  
Vol 30 (21) ◽  
pp. 2678-2683 ◽  
Author(s):  
Farhad Azimi ◽  
Richard A. Scolyer ◽  
Pavlina Rumcheva ◽  
Marc Moncrieff ◽  
Rajmohan Murali ◽  
...  
Keyword(s):  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Cutaneous Melanoma ◽  
Independent Predictor ◽  
Primary Melanoma ◽  
Mitotic Rate ◽  
Tumor Thickness ◽  
Lymph Node Status ◽  
Inverse Association ◽  
Grade 3

Purpose To determine whether density and distribution of tumor-infiltrating lymphocytes (TILs; TIL grade) is an independent predictor of sentinel lymph node (SLN) status and survival in patients with clinically localized primary cutaneous melanoma. Methods From the Melanoma Institute Australia database, 1,865 patients with a single primary melanoma ≥ 0.75 mm in thickness were identified. The associations of clinical and pathologic factors with SLN status, recurrence-free survival (RFS), and melanoma-specific survival (MSS) were analyzed. Results The majority of patients had either no (TIL grade 0; 35.4%) or few (TIL grade 1; 45.1%) TILs, with a minority showing moderate (TIL grade 2; 16.3%) or marked (TIL grade 3; 3.2%) TILs. Tumor thickness, mitotic rate, and Clark level were inversely correlated with TIL grade (each P < .001). SLN biopsy was performed in 1,138 patients (61.0%) and was positive in 252 (22.1%). There was a significant inverse association between SLN status and TIL grade (SLN positivity rates for each TIL grade: 0, 27.8%; 1, 20.1%; 2, 18.3%; 3, 5.6%; P < .001). Predictors of SLN positivity were decreasing age (P < .001), decreasing TIL grade (P < .001), ulceration (P = .003), increasing tumor thickness (P = .01), satellitosis (P = .03), and increasing mitoses (P = .03). The 5-year MSS and RFS rates were 83% and 76%, respectively (median follow-up, 43 months). Tumor thickness (P < .001), ulceration (P < .001), satellitosis (P < .001), mitotic rate (P = .003), TIL grade (P < .001), and sex (P = .01) were independent predictors of MSS. Patients with TIL grade 3 tumors had 100% survival. Conclusion TIL grade is an independent predictor of survival and SLN status in patients with melanoma. Patients with a pronounced TIL infiltrate have an excellent prognosis.

Considerations for Timing of Defect Reconstruction in Cutaneous Melanoma of the Head and Neck

2019 ◽  
Vol 35 (04) ◽  
pp. 404-409 ◽  
Author(s):  
Arya W. Namin ◽  
Georgeanne E. Cornell ◽  
Emily H. Smith ◽  
Robert P. Zitsch
Keyword(s):  
Head And Neck ◽  
Local Excision ◽  
Cutaneous Melanoma ◽  
Wide Local Excision ◽  
Tumor Thickness ◽  
Margin Status ◽  
Lentigo Maligna ◽  
Positive Margins ◽  
Lentigo Maligna Melanoma ◽  
Delayed Reconstruction

AbstractThe objective of this study is to identify the incidence and characteristics of cases with positive margins on wide local excision for cutaneous melanoma of the head and neck (CMHN) and therefore provide a potential basis for selectively delaying reconstruction pending final histological clearance of melanoma. A systematic review of English language articles was performed on studies retrieved from PubMed and Web of Science. Original investigations published between July 1999 and June 2018 reporting on margin status of CMHN wide local excision specimens were included in the review. The incidence of positive margins after definitive resection for cutaneous melanoma in the literature ranges from 6 to 20.9%. The incidence is higher in cases of advanced patient age, diagnosis by shave biopsy, lentigo maligna melanoma subtype, desmoplastic subtype, tumor thickness, and ulceration. Delayed reconstruction remains the most oncologically sound decision, allowing for interpretation of margin status on paraffin-embedded tissue sections. However, resection and the resultant defect closure in a single stage is more expedient and potentially a more efficient use of resources. The risk–benefit ratio of immediate versus delayed reconstruction must be considered for each case. The incidence of positive margins is higher in cases of advanced patient age, diagnosis by shave biopsy, lentigo maligna melanoma subtype, desmoplastic subtype, increasing tumor thickness, and the presence of ulceration; delayed reconstruction should be strongly considered in these cases.

Tumor Vascularity in the Prognostic Assessment of Primary Cutaneous Melanoma

2002 ◽  
Vol 20 (7) ◽  
pp. 1826-1831 ◽  
Author(s):  
Mohammed Kashani-Sabet ◽  
Richard W. Sagebiel ◽  
Carlos M.M. Ferreira ◽  
Mehdi Nosrati ◽  
James R. Miller
Keyword(s):  
Overall Survival ◽  
Prognostic Factor ◽  
San Francisco ◽  
Cutaneous Melanoma ◽  
Primary Tumor ◽  
Tumor Thickness ◽  
Prognostic Impact ◽  
Tumor Vascularity ◽  
Primary Cutaneous Melanoma ◽  
Prognostic Assessment

PURPOSE: The vascular supply of the primary tumor is recognized to play an important role in the progression of a number of solid tumors. However, the role of tumor vascularity in the prognostic assessment of melanoma remains unclear. The purpose of this study was to determine the prognostic impact of patterns of vascularity on the outcome associated with cutaneous melanoma. PATIENTS AND METHODS: Tumor vascularity was documented prospectively using routine histopathologic analysis of 417 primary cutaneous melanomas from the University of California at San Francisco Melanoma Center database. Four patterns of tumor vascularity were recorded: absent, sparse, moderate, and prominent. RESULTS: Increasing tumor vascularity significantly increased the risk of relapse and death associated with melanoma, corresponding to reduced relapse-free and overall survival. By multivariate analysis, tumor vascularity was the most important determinant of overall survival, surpassing tumor thickness. Increasing tumor vascularity was associated with increased incidence of ulceration in the primary tumor. CONCLUSION: Tumor vascularity is an important prognostic factor in melanoma, rivaling tumor thickness. Increasing tumor vascularity is highly correlated with ulceration, possibly helping to explain the biologic basis of this known prognostic factor.

scholarly journals Primary cutaneous melanoma. Optimized cutoff points of tumor thickness and importance of clark's level for prognostic classification

Cancer ◽  
1995 ◽  
Vol 75 (10) ◽  
pp. 2499-2506 ◽  
Author(s):  
Petra Büttner ◽  
Claus Garbe ◽  
Jochen Bertz ◽  
Günter Burg ◽  
Barbara D'Hoedt ◽  
...  
Keyword(s):  
Cutaneous Melanoma ◽  
Tumor Thickness ◽  
Primary Cutaneous Melanoma ◽  
Cutoff Points

Acral lentiginous melanoma: Population-based analysis of incidence and survival in United States from 1993 to 2013.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e22108-e22108
Author(s):  
Nishitha Thumallapally ◽  
Ahmed Meshref ◽  
Mohammed Mousa
Keyword(s):  
Cutaneous Melanoma ◽  
Survival Rates ◽  
Relative Survival ◽  
Incidence Rates ◽  
Tumor Thickness ◽  
Pacific Islanders ◽  
Acral Lentiginous Melanoma ◽  
Asian Pacific Islanders ◽  
Asian Pacific ◽  
Adjusted Incidence

e22108 Background: Acral Lentiginous melanoma (ALM) is a rare form of cutaneous melanoma with aggressive nature. This study investigates the incidence and survival patterns in patients diagnosed with ALM in USA from 1993-2013 using data from the Surveillance, Epidemiology, and End Results (SEER) Registry. Methods: The 18 cancer registries of SEER program were used to identify patients diagnosed with ALM according to international classification of diseases for oncology (ICDO-3) codes. Age adjusted incidence rates in addition to 5 and 10-year relative survival rates were calculated. Results: 2189 patients were included in this retrospective study.The age-adjusted incidence rate of ALM was 2.11 per million person-years.Hispanic whites had highest incidence rates of ALM among all racial subgroups ( 2.58, p = 0.005). Incidence of ALM was higher between 2003-2013 compared to 1993-2003 (2.3 vs 1.9).Median age at diagnosis was 61.68 years. 53.9 % were female. Our study population was dominated by Non-Hispanic Whites (69.2%) followed by Hispanic Whites (13.5%), Blacks (8.2%), Asians or Pacific Islanders (7.3%) and other races (1.8%). stage III was the most frequent (24.7%) followed by stage I (20.9%). In terms of tumor thickness, 43.2 % presented with T3 thickness at the time of diagnosis. The ALM 5 - and 10-year survival rates were highest in age < 40, females, T1, non ulcerated, lymph node negative lesions ( p < 0.05). Among racial subgroups, non Hispanic whites had highest survival rates (83 vs 74 % ). Asian/Pacific Islanders (75.1%vs 49.8%) had lowest survival rates followed Hispanic whites ( 76.4 % vs 63.9 ) and Blacks (74.7 vs 71.5 %) ( p = 0.19). Conclusions: ALM is rare subtype of cutaneous melanoma with increased incidence in people of color. Patients present with increased tumor thickness and advanced stage at the time of diagnosis. Poor survival rates are seen among Asian/Pacific Islanders and Hispanic whites.

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