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Clinical node-negative thick melanoma.

George I Salti1, Ashwin Kansagra, Michael A Warso

  • 1Department of Surgical Oncology (Mail Code 820), 840 S Wood St, College of Medicine, University of Illinois at Chicago, 60612, USA. geosalti@uic.edu

Archives of Surgery (Chicago, Ill. : 1960)
|March 13, 2002
PubMed
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Thick melanoma patients (T4 N0 M0) have variable outcomes; lymph node status is a key predictor of survival, not just tumor thickness. Adjuvant therapy decisions should consider multiple prognostic factors beyond melanoma depth.

Area of Science:

  • Dermatology
  • Surgical Oncology
  • Oncology

Background:

  • Patients with T4 N0 M0 melanoma are considered high-risk for occult metastases, often leading to recommendations for adjuvant therapy.
  • However, long-term survival in patients with thick melanoma is not universally poor.

Purpose of the Study:

  • To evaluate prognostic factors for survival in patients with thick, node-negative melanoma.
  • To determine if tumor thickness alone is a sufficient criterion for adjuvant therapy decisions.

Main Methods:

  • Retrospective study conducted at a university teaching hospital.
  • Analysis of 151 patients with clinical node-negative, thick (≥4.0 mm) melanoma who underwent primary surgical treatment without adjuvant therapy.
  • Median follow-up was 44 months.

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Main Results:

  • Median overall survival (OS) was 70 months (5-year survival, 52%) and median disease-free survival (DFS) was 51 months (5-year survival, 47%).
  • Node-positive disease significantly worsened outcomes compared to node-negative disease (Median OS: 49 vs. 209 months; Median DFS: 32 vs. 165 months).
  • Higher mitoses (≥5/mm²) and head/neck location also correlated with lower OS and DFS. Lymph node status was the most predictive variable.

Conclusions:

  • Melanoma thickness alone should not dictate adjuvant therapy.
  • Prognostic factors such as lymph node status, mitoses, and tumor location are crucial for treatment decisions in thick melanoma patients.