Outcomes and prognostic factors in nodular melanomas

Area of Science:

• Dermatology
• Oncology
• Surgical Pathology

Background:

• Nodular melanoma exhibits distinct vertical growth, differing from other melanoma subtypes.
• Understanding prognostic factors is crucial for managing nodular melanoma outcomes.

Purpose of the Study:

• To identify prognostic factors and evaluate outcomes specifically for nodular melanoma.
• To analyze survival data in relation to clinical and pathological features.

Main Methods:

• Post hoc analysis of a prospective clinical trial involving patients with nodular melanoma.
• Univariate, multivariate, and Kaplan-Meier survival analyses were conducted for disease-free survival (DFS), overall survival (OS), and local/in-transit recurrence-free survival (LITRFS).

Main Results:

• Breslow thickness (≥2.3 mm), ulceration, non-extremity location, and sentinel lymph node (SLN) positivity were independent risk factors for worse OS and DFS.
• Ulceration predicted poorer OS and DFS across all nodular melanoma patients, including SLN-positive and -negative subsets.
• The combination of ulceration and positive SLN status significantly worsened DFS and OS.

Conclusions:

• Sentinel lymph node (SLN) status and tumor ulceration are the most critical prognostic indicators for nodular melanoma.
• The presence of both a positive SLN and ulceration significantly impacts DFS and OS, with a lesser effect on LITRFS.