Outcome of thick (> 4 mm) node-negative melanomas

Area of Science:

• Oncology
• Dermatology
• Surgical Oncology

Background:

• Thick melanomas (>4 mm) pose a significant risk for metastatic disease.
• Management strategies for thick melanomas lack consensus, with some questioning surgical intervention.
• Historically, poor prognosis has led to a nihilistic approach for advanced melanoma cases.

Purpose of the Study:

• To evaluate outcomes for node-negative patients with thick melanomas treated at a specialized center.
• To assess the survival rates and recurrence patterns in this high-risk melanoma cohort.

Main Methods:

• Retrospective review of a melanoma patient database.
• Inclusion criteria: thick melanomas (>4 mm), clinically or sentinel node biopsy negative (T4N0, stage IIb/IIc).
• Median follow-up of 4 years for identified patients.

Main Results:

• 23 patients met the criteria; 18 (78%) survived with a median follow-up of 4 years.
• Five patients died from metastatic disease; 14 of 18 survivors had no evidence of disease post-resection.
• Recurrences were predominantly non-nodal, suggesting hematogenous spread.

Conclusions:

• Survival exceeds 75% at 4 years for thick, node-negative melanomas.
• Hematogenous spread with lymphatic sparing was the primary failure pattern.
• Future research should investigate tumor biology inhibiting lymphatic metastasis.