A single institution 18-years retrospective analysis of malignant melanoma

Melanoma accounts for about 2% of all cancer-related mortality in western populations. Surgical excision of localized disease is curative in many patients with 80% overall 5-year survival rate. There are many indicators of prognosis of which tumor burden is predicted by primary site with nodal status being the next most important variable. Patients with advanced stage have very high risk of developing distant metastases and should receive systemic therapy. Despite treatment, majority of locally advanced patients develop metastatic disease.

A retrospective analysis of cases of malignant melanoma registered over a period of eighteen years, from October 1990 to September 2007 was done. Patient profile, presentation, disease load, treatment protocols and response on or after treatment were analyzed.

The median age at diagnosis in men was 48 years and 50 years in women. At presentation, more than half of studied cases (56.5%) presented with nodal metastases at diagnosis while about three fourths (74%) had distant metastases (stage IV disease). More than half (56%) of the patients had superficial spreading type. The most common presenting complaints were swelling (70% of patients), ulcer (50% of patients) or pain (50%). Primary sites included extremities, central nervous system, abdomen, trunk, and bones. Liver, brain, abdomen and lungs were common metastatic sites. Surgical excision of primary lesion was done in about half of the cases. Four patients subsequently received palliative radiotherapy and two more received adjuvant radiotherapy. Another six patients received adjuvant chemotherapy and radiotherapy. Among treated patients, 26% showed partial response and another 8% have stable disease while 65% patients progressed on or after initial treatment.

Malignant melanoma carries an overall poor prognosis especially in advanced stages. Multimodality therapy with surgery, radiotherapy and chemotherapy may provide local or nodal remission but cannot improve long term survival in advanced cases.