Long Term Results of Surgical Treatment of Melanoma of the Limbs

The outcome of surgical treatment of malignant melanoma has been evaluated on the basis of 157 limbs patients observed at the National Cancer Institute of Milan from January 1950 to December 1973. It was found that sex, site of origin and excisional biopsy do not affect the prognosis. The presence of regional nodes metastases is the factor that weight most heavily on long term results: 57.6% of patients without regional node metastases and only 15.2% of patients with positive bodes are free of disease 10 years after treatment. The depth of invasion and histological type of melanoma were found to be useful because they reveal the potential aggressiveness of the tumor: 2 out of 11 cases of lentigo maligna, 4 out of 55 cases of superficial spreading melanoma, 23 out of 91 cases of nodular melanoma and 12 out of 79 cases of Clark's level III, 8 out of 44 level IV and 8 out of 14 level V had regional nodes metastases. These two parameters were found to be correlated: lentigo maligna and superficial spreading melanoma infiltrate little as a rule whereas about half of nodular melanoma were classified as levels IV or V. Since there is not at present a definite evidence that an « elective » node dissection achieves better risults than excision only of primary melanoma followed by a possible « curative » dissection the so called « prophilactic » node dissection is considered mainly as a « staging » procedure and indicated only for level V melanoma where the incidence of nodes metastases is higher than 50%.