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Effect of Anatomical Location on Prognosis in Patients With Clinical Stage I Melanoma

Effect of Anatomical Location on Prognosis in Patients With Clinical Stage I Melanoma Abstract • A study of the influence of the anatomical location of malignant melanoma on the prognosis of 971 patients with stage I disease disclosed specific high-, intermediate-, and low-risk sites. High-risk sites included scalp, mandibular area, midline of trunk (anterior and posterior), upper medial thighs, hands, feet (except the arches), popliteal fossae, and genitalia. The life-table-adjusted five-year disease-free survival was 54% in the high-risk locations, 79% in intermediate-risk locations, and 93% in low-risk sites. A Cox proportional hazards analysis demonstrated that the grouping of lesions by their anatomical risk location had prognostic value that was significant in a model of eight other known predictive variables (thickness, sex, age, type, level, mitotic index, ulceration, and presence of preexistent nevus). The results indicate that anatomical location of the primary melanoma is significantly associated with five-year disease-free survival. (Arch Dermatol 1983;119:644-649) References 1. Clark WM, From L, Bernardino EA, et al: The histogenesis and biologic behavior of primary human malignant melanomas of the skin . Cancer Res 1969;29:705-715. 2. Breslow A: Thickness, cross-sectional areas and depth of invasion in the prognosis of cutaneous melanoma . Ann Surg 1970; 172:902-906.Crossref 3. Balch CM, Murad TM, Soong SJ, et al: A multifactorial analysis of melanoma: I. Prognostic histopathological features comparing Clark's and Breslow's staging methods . Ann Surg 1978; 188:732-742.Crossref 4. Balch CM, Soong SJ, Murad TM, et al: A multifactorial analysis of melanoma: II. Prognostic features of clinical stage I disease . Surgery 1979;86:343-351. 5. Balch CM, Wilkerson JA, Murad TM, et al: The prognostic significance of ulceration of cutaneous melanoma . Cancer 1980; 45:3012-3017.Crossref 6. Balch CM, Soong SJ, Murad TM, et al: Prognostic factors analysis of melanoma patients with regional lymph node metastases (stage II) , in the Proceedings of the American Association for Cancer Research, May 28-31, 1980 . New York, American Association for Cancer Research, 1980, vol 21, p 169. 7. Cohen MH, Ketcham AS, Felix EL, et al: Prognostic factors in patients undergoing lymphadenectomy for malignant melanoma . Ann Surg 1977;186:635-642.Crossref 8. Cox DR: Analysis of Binary Data . London, Chapman & Hall, 1970. 9. Cox DR: Regression model and life tables . J Roy Stat Soc 1972;B34:187-220. 10. Day CL, Sober AJ, Kopf AW, et al: A prognostic model for clinical stage I melanoma of the upper extremity: The importance of anatomic subsites in predicting recurrent disease . Ann Surg 1981;193:436-440.Crossref 11. Day CL, Sober AJ, Kopf AW, et al: A prognostic model for clinical stage I melanoma of the lower extremity: Location on the foot is an independent risk factor for recurrent disease . Surgery 1981;89:599-603. 12. Eldh J, Boeryd B, Peterson LE: Prognostic factors in cutaneous malignant melanoma in stage I . Scand J Plast Reconstr Surg 1978;12:243-255.Crossref 13. Kopf AW, Rigel DS, Bart RS, et al: Factors related to thickness of melanoma . J Dermatol Surg Oncol 1981;7:645-650.Crossref 14. McGovern VJ, Shaw HM, Milton GW, et al: Prognostic significance of the histologic features of malignant melanoma . Histopathology 1979;3:385-393.Crossref 15. Rigel DS, Friedman RJ, Kopf AW, et al: Malignant melanoma: A prognostic scoring system based on factors influencing early vs. late death . JAMA , in press. 16. Jones WM, Jones Williams W, Roberts MM, et al: Malignant melanoma of the skin: Prognostic values of clinical feature and the role of treatment in 111 cases . Br J Cancer 1968;22:437-451.Crossref 17. Mackie RM, Curfrae DC, Cochran AJ: Assessment of prognosis in patients with malignant melanoma . Lancet 1972;2:455-456.Crossref 18. Davis NC, McLeod GR, Beardmore GL, et al: Primary cutaneous melanomas: A report from the Queensland melanoma project . CA 1976;26:80-107. 19. Sugarbaker EV, McBride CM: Melanoma of the trunk: The results of surgical excision and anatomic guidelines for predicting nodal metastasis . Surgery 1976;80:22-30. 20. Nie NH, Hull CM, Jenkins JG, et al: Statistical Package for the Social Sciences . New York, McGraw-Hill Book Co, 1975. 21. Lee ET, Desu MM: A computer program for comparison of K samples with right-censored data . Comput Programs Biomed 1972;2:315-329.Crossref 22. SAS Supplemental Library User's Guide . Cary, NC, SAS Institute Inc, 1979. 23. Cohen J: Statistical Power Analysis for the Behavioral Sciences . New York, Academic Press Inc, 1969. 24. Allen AM: Clinical trials in dermatology: II. Numbers of patients required . Int J Dermatol 1978;17:194-203.Crossref 25. McNeer G, Das Gupta T: Prognosis in malignant melanoma . Surgery 1964;56:512-518. 26. Block GE, Hartwell SW: Malignant melanoma: A study of 217 cases . Ann Surg 1964;154( (suppl) ):74-109.Crossref 27. Veronesi U: Inefficacy of immediate node dissection in stage I melanoma of the limbs . N Engl J Med 1977;297:627-630.Crossref 28. Kopf AW, Bart RS, Rodriguez-Sains RS, et al: Malignant Melanoma . New York, Masson Publishing, 1979. 29. Day CL, Sober AJ, Kopf AW, et al: A prognostic model for clinical stage I melanoma of the trunk . Am J Surg 1981;142:247-251.Crossref 30. Roses DF, Harris MN, Grunberger I, et al: Selective surgical management of cutaneous melanoma of the head and neck . Ann Surg 1980;192:629-632.Crossref 31. Roses DF, Harris MN, Gumport SL: Surgical management for malignant melanoma of the trunk . Arch Surg 1981;116:315-317.Crossref 32. Roses DF, Harris MN, Stern JS, et al: Cutaneous melanoma of the breast . Ann Surg 1979;189:112-115.Crossref 33. Roses DF, Harris MN, Gumport SL, et al: Regional lymph node dissection for malignant melanoma of the extremities . Surgery 1981;89:654-659. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Dermatology American Medical Association

Effect of Anatomical Location on Prognosis in Patients With Clinical Stage I Melanoma

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Publisher
American Medical Association
Copyright
Copyright © 1983 American Medical Association. All Rights Reserved.
ISSN
0003-987X
eISSN
1538-3652
DOI
10.1001/archderm.1983.01650320018009
Publisher site
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Abstract

Abstract • A study of the influence of the anatomical location of malignant melanoma on the prognosis of 971 patients with stage I disease disclosed specific high-, intermediate-, and low-risk sites. High-risk sites included scalp, mandibular area, midline of trunk (anterior and posterior), upper medial thighs, hands, feet (except the arches), popliteal fossae, and genitalia. The life-table-adjusted five-year disease-free survival was 54% in the high-risk locations, 79% in intermediate-risk locations, and 93% in low-risk sites. A Cox proportional hazards analysis demonstrated that the grouping of lesions by their anatomical risk location had prognostic value that was significant in a model of eight other known predictive variables (thickness, sex, age, type, level, mitotic index, ulceration, and presence of preexistent nevus). The results indicate that anatomical location of the primary melanoma is significantly associated with five-year disease-free survival. (Arch Dermatol 1983;119:644-649) References 1. Clark WM, From L, Bernardino EA, et al: The histogenesis and biologic behavior of primary human malignant melanomas of the skin . Cancer Res 1969;29:705-715. 2. Breslow A: Thickness, cross-sectional areas and depth of invasion in the prognosis of cutaneous melanoma . Ann Surg 1970; 172:902-906.Crossref 3. Balch CM, Murad TM, Soong SJ, et al: A multifactorial analysis of melanoma: I. Prognostic histopathological features comparing Clark's and Breslow's staging methods . Ann Surg 1978; 188:732-742.Crossref 4. Balch CM, Soong SJ, Murad TM, et al: A multifactorial analysis of melanoma: II. Prognostic features of clinical stage I disease . Surgery 1979;86:343-351. 5. Balch CM, Wilkerson JA, Murad TM, et al: The prognostic significance of ulceration of cutaneous melanoma . Cancer 1980; 45:3012-3017.Crossref 6. Balch CM, Soong SJ, Murad TM, et al: Prognostic factors analysis of melanoma patients with regional lymph node metastases (stage II) , in the Proceedings of the American Association for Cancer Research, May 28-31, 1980 . New York, American Association for Cancer Research, 1980, vol 21, p 169. 7. Cohen MH, Ketcham AS, Felix EL, et al: Prognostic factors in patients undergoing lymphadenectomy for malignant melanoma . Ann Surg 1977;186:635-642.Crossref 8. Cox DR: Analysis of Binary Data . London, Chapman & Hall, 1970. 9. Cox DR: Regression model and life tables . J Roy Stat Soc 1972;B34:187-220. 10. Day CL, Sober AJ, Kopf AW, et al: A prognostic model for clinical stage I melanoma of the upper extremity: The importance of anatomic subsites in predicting recurrent disease . Ann Surg 1981;193:436-440.Crossref 11. Day CL, Sober AJ, Kopf AW, et al: A prognostic model for clinical stage I melanoma of the lower extremity: Location on the foot is an independent risk factor for recurrent disease . Surgery 1981;89:599-603. 12. Eldh J, Boeryd B, Peterson LE: Prognostic factors in cutaneous malignant melanoma in stage I . Scand J Plast Reconstr Surg 1978;12:243-255.Crossref 13. Kopf AW, Rigel DS, Bart RS, et al: Factors related to thickness of melanoma . J Dermatol Surg Oncol 1981;7:645-650.Crossref 14. McGovern VJ, Shaw HM, Milton GW, et al: Prognostic significance of the histologic features of malignant melanoma . Histopathology 1979;3:385-393.Crossref 15. Rigel DS, Friedman RJ, Kopf AW, et al: Malignant melanoma: A prognostic scoring system based on factors influencing early vs. late death . JAMA , in press. 16. Jones WM, Jones Williams W, Roberts MM, et al: Malignant melanoma of the skin: Prognostic values of clinical feature and the role of treatment in 111 cases . Br J Cancer 1968;22:437-451.Crossref 17. Mackie RM, Curfrae DC, Cochran AJ: Assessment of prognosis in patients with malignant melanoma . Lancet 1972;2:455-456.Crossref 18. Davis NC, McLeod GR, Beardmore GL, et al: Primary cutaneous melanomas: A report from the Queensland melanoma project . CA 1976;26:80-107. 19. Sugarbaker EV, McBride CM: Melanoma of the trunk: The results of surgical excision and anatomic guidelines for predicting nodal metastasis . Surgery 1976;80:22-30. 20. Nie NH, Hull CM, Jenkins JG, et al: Statistical Package for the Social Sciences . New York, McGraw-Hill Book Co, 1975. 21. Lee ET, Desu MM: A computer program for comparison of K samples with right-censored data . Comput Programs Biomed 1972;2:315-329.Crossref 22. SAS Supplemental Library User's Guide . Cary, NC, SAS Institute Inc, 1979. 23. Cohen J: Statistical Power Analysis for the Behavioral Sciences . New York, Academic Press Inc, 1969. 24. Allen AM: Clinical trials in dermatology: II. Numbers of patients required . Int J Dermatol 1978;17:194-203.Crossref 25. McNeer G, Das Gupta T: Prognosis in malignant melanoma . Surgery 1964;56:512-518. 26. Block GE, Hartwell SW: Malignant melanoma: A study of 217 cases . Ann Surg 1964;154( (suppl) ):74-109.Crossref 27. Veronesi U: Inefficacy of immediate node dissection in stage I melanoma of the limbs . N Engl J Med 1977;297:627-630.Crossref 28. Kopf AW, Bart RS, Rodriguez-Sains RS, et al: Malignant Melanoma . New York, Masson Publishing, 1979. 29. Day CL, Sober AJ, Kopf AW, et al: A prognostic model for clinical stage I melanoma of the trunk . Am J Surg 1981;142:247-251.Crossref 30. Roses DF, Harris MN, Grunberger I, et al: Selective surgical management of cutaneous melanoma of the head and neck . Ann Surg 1980;192:629-632.Crossref 31. Roses DF, Harris MN, Gumport SL: Surgical management for malignant melanoma of the trunk . Arch Surg 1981;116:315-317.Crossref 32. Roses DF, Harris MN, Stern JS, et al: Cutaneous melanoma of the breast . Ann Surg 1979;189:112-115.Crossref 33. Roses DF, Harris MN, Gumport SL, et al: Regional lymph node dissection for malignant melanoma of the extremities . Surgery 1981;89:654-659.

Journal

Archives of DermatologyAmerican Medical Association

Published: Aug 1, 1983

References