Clinical assessment of melanoma thickness

Melanoma tumour thickness is the best current predictor of prognosis. In 92 patients melanoma tumour thickness was estimated preoperatively on clinical assessment and compared to the histological thickness measured from fixed paraffin sections. Overall there was no significant difference between clinical and histological thickness. The two assessments were identical in 20 of 92 cases (22%). In 32 of the 92 cases (35%) there was a discrepancy greater than 25%, but 87 of the 92 patients had appropriate treatment where extent of surgery was tailored to clinical assessment of treatment. Clinical assessment has an important role in identifying occasional spurious histological thickness measurements, resulting from sampling errors. The ability to gauge melanoma thickness preoperatively also aids the planning of a rational treatment policy ranging from conservative treatment for thin lesions to radical surgery, which may include elective node dissection and adjuvant limb perfusion, for thicker tumours.