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Cutaneous Thick Melanoma: Prognosis and Treatment

Cutaneous Thick Melanoma: Prognosis and Treatment Abstract • Among proponents of elective lymph node dissection (ELND) for clinical stage I melanoma, controversy exists as to whether there is an upper limit of tumor thickness beyond which ELND should not be considered. We reviewed 169 patients with clinical stage I and II melanoma that was greater than or equal to 3.0 mm thick and who were treated at the University of Illinois Hospital, Chicago. Of 139 patients with clinical stage I disease, 117 underwent ELND. Five- and ten-year survival rates were 55.7% and 48.9%, respectively. Multifactorial analysis demonstrated that anatomical location, level, pathologic stage, and ulceration were the best predictors of survival. Thickness did not emerge as a significant variable. Our findings do not support basing treatment decisions, eg, ELND in this group of patients, solely on the thickness of the primary tumor. We continue to recommend ELND in patients with either intermediate or thick melanomas. (Arch Surg 1987;122:707-711) References 1. Balch CM, Cascinelli N, Milton GW: Elective lymph node dissection: Pros and cons , in Balch CM, Milton GW, Shaw HM, Soong SJ (eds): Cutaneous Melanoma: Clinical Management and Treatment: Results Worldwide . Philadelphia, JB Lippincott, 1985, pp 131-157. 2. Veronisi U, Adamus J, Bandiera DC, et al: Inefficacy of immediate node dissection in stage I melanoma of the limbs . N Engl J Med 1977;297: 627-630.Crossref 3. Veronisi U, Adamus J, Bandiera DC, et al: Delayed regional lymph node dissection in stage I melanoma of the skin of the lower extremities . Cancer 1982;49:2420-2430.Crossref 4. Sim FH, Taylor WF, Ivins JC, et al: A prospective randomized study of the efficacy of routine elective lymphadenectomy in management of malignant melanoma: Preliminary results . Cancer 1978;41:948-956.Crossref 5. Sim FH, Taylor WF, Pritchard DI, et al: Lymphadenectomy in the management of stage I malignant melanoma: A prospective randomized study . Mayo Clin Proc 1986;61:697-705.Crossref 6. Balch CM, Soong SJ, Murad TM, et al: A multifactorial analysis of melanoma: II. Prognostic factors in patients with stage I (localized) melanoma . Surgery 1979;86:343-351. 7. Das Gupta TK: Results of treatment of 269 patients with primary cutaneous melanoma: A five-year prospective study . Ann Surg 1977;186: 201-209.Crossref 8. Milton GW, Shaw HM, McCarthy WH, et al: Prophylactic lymph node dissection in clinical stage I cutaneous malignant melanoma: Results of surgical treatment in 1319 patients . Br J Surg 1982;69:108-111.Crossref 9. Reintgen DS, Cox EB, McCarthy KS Jr, et al: Efficacy of elective lymph node dissection in patients with intermediate thickness primary melanoma . Ann Surg 1983;198:379-384.Crossref 10. Wanebo HJ, Woodruff J, Fortner JG: Malignant melanoma of the extremities: A clinicopathologic study using levels of invasion (microstage) . Cancer 1975;35:666-676.Crossref 11. Balch CM, Soong SJ, Milton GW, et al: A comparison of prognostic factors and surgical results in 1786 patients with localized (stage I) melanoma treated in Alabama, USA, and New South Wales, Australia . Ann Surg 1982;196:677-684.Crossref 12. McCarthy WH, Shaw HM, Milton GW: Efficacy of elective lymph node dissection in 2347 patients with clinical stage I malignant melanoma . Surg Gynecol Obstet 1985;161:575-580. 13. Day CL Jr, Lew RA, Mihm MC, et al: A multivariate analysis of prognostic factors for melanoma patients with lesions ≥3.65 mm in thickness . Ann Surg 1982;195:44-49.Crossref 14. Kaplan EL, Meier P: Non-parametric estimation from incomplete observations . J Am Statist Assoc 1958;53:457-481.Crossref 15. Breslow N: A generalized Kruskal-Wallis test for comparing κ samples subject to unequal patterns of censorship . Biometrika 1970;57:579-594.Crossref 16. Cox DR: Regression model and life tables . J R Statist Soc Br 1972;34:187-220. 17. Balch CM, Soong SJ, Shaw HM: An analysis of prognostic factors in 4000 patients with cutaneous melanoma , in Balch CM, Milton GW, Shaw HM, et al (eds): Cutaneous Melanoma: Clinical Management and Treatment: Results Worldwide . Philadelphia, JB Lippincott, 1985, pp 321-352. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

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Publisher
American Medical Association
Copyright
Copyright © 1987 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1987.01400180089017
Publisher site
See Article on Publisher Site

Abstract

Abstract • Among proponents of elective lymph node dissection (ELND) for clinical stage I melanoma, controversy exists as to whether there is an upper limit of tumor thickness beyond which ELND should not be considered. We reviewed 169 patients with clinical stage I and II melanoma that was greater than or equal to 3.0 mm thick and who were treated at the University of Illinois Hospital, Chicago. Of 139 patients with clinical stage I disease, 117 underwent ELND. Five- and ten-year survival rates were 55.7% and 48.9%, respectively. Multifactorial analysis demonstrated that anatomical location, level, pathologic stage, and ulceration were the best predictors of survival. Thickness did not emerge as a significant variable. Our findings do not support basing treatment decisions, eg, ELND in this group of patients, solely on the thickness of the primary tumor. We continue to recommend ELND in patients with either intermediate or thick melanomas. (Arch Surg 1987;122:707-711) References 1. Balch CM, Cascinelli N, Milton GW: Elective lymph node dissection: Pros and cons , in Balch CM, Milton GW, Shaw HM, Soong SJ (eds): Cutaneous Melanoma: Clinical Management and Treatment: Results Worldwide . Philadelphia, JB Lippincott, 1985, pp 131-157. 2. Veronisi U, Adamus J, Bandiera DC, et al: Inefficacy of immediate node dissection in stage I melanoma of the limbs . N Engl J Med 1977;297: 627-630.Crossref 3. Veronisi U, Adamus J, Bandiera DC, et al: Delayed regional lymph node dissection in stage I melanoma of the skin of the lower extremities . Cancer 1982;49:2420-2430.Crossref 4. Sim FH, Taylor WF, Ivins JC, et al: A prospective randomized study of the efficacy of routine elective lymphadenectomy in management of malignant melanoma: Preliminary results . Cancer 1978;41:948-956.Crossref 5. Sim FH, Taylor WF, Pritchard DI, et al: Lymphadenectomy in the management of stage I malignant melanoma: A prospective randomized study . Mayo Clin Proc 1986;61:697-705.Crossref 6. Balch CM, Soong SJ, Murad TM, et al: A multifactorial analysis of melanoma: II. Prognostic factors in patients with stage I (localized) melanoma . Surgery 1979;86:343-351. 7. Das Gupta TK: Results of treatment of 269 patients with primary cutaneous melanoma: A five-year prospective study . Ann Surg 1977;186: 201-209.Crossref 8. Milton GW, Shaw HM, McCarthy WH, et al: Prophylactic lymph node dissection in clinical stage I cutaneous malignant melanoma: Results of surgical treatment in 1319 patients . Br J Surg 1982;69:108-111.Crossref 9. Reintgen DS, Cox EB, McCarthy KS Jr, et al: Efficacy of elective lymph node dissection in patients with intermediate thickness primary melanoma . Ann Surg 1983;198:379-384.Crossref 10. Wanebo HJ, Woodruff J, Fortner JG: Malignant melanoma of the extremities: A clinicopathologic study using levels of invasion (microstage) . Cancer 1975;35:666-676.Crossref 11. Balch CM, Soong SJ, Milton GW, et al: A comparison of prognostic factors and surgical results in 1786 patients with localized (stage I) melanoma treated in Alabama, USA, and New South Wales, Australia . Ann Surg 1982;196:677-684.Crossref 12. McCarthy WH, Shaw HM, Milton GW: Efficacy of elective lymph node dissection in 2347 patients with clinical stage I malignant melanoma . Surg Gynecol Obstet 1985;161:575-580. 13. Day CL Jr, Lew RA, Mihm MC, et al: A multivariate analysis of prognostic factors for melanoma patients with lesions ≥3.65 mm in thickness . Ann Surg 1982;195:44-49.Crossref 14. Kaplan EL, Meier P: Non-parametric estimation from incomplete observations . J Am Statist Assoc 1958;53:457-481.Crossref 15. Breslow N: A generalized Kruskal-Wallis test for comparing κ samples subject to unequal patterns of censorship . Biometrika 1970;57:579-594.Crossref 16. Cox DR: Regression model and life tables . J R Statist Soc Br 1972;34:187-220. 17. Balch CM, Soong SJ, Shaw HM: An analysis of prognostic factors in 4000 patients with cutaneous melanoma , in Balch CM, Milton GW, Shaw HM, et al (eds): Cutaneous Melanoma: Clinical Management and Treatment: Results Worldwide . Philadelphia, JB Lippincott, 1985, pp 321-352.

Journal

Archives of SurgeryAmerican Medical Association

Published: Jun 1, 1987

References