Ulceration and prognosis in cutaneous malignant melanoma

A review of 1818 patients with cutaneous malignant melanoma revealed that for both patients with localized disease (clinical stage I) and those with regional lymph node metastases at first presentation (clinical stage II), ulceration of the primary lesion was a poor prognostic sign. Although ulcerated lesions tended to be considerably thicker than non-ulcerated lesions, this factor did not entirely explain the poor prognosis recorded for patients with ulcerated lesions. In men and women matched by the thickness of their tumours, prognosis for those with ulcerated lesions was worse than for those with non-ulcerated lesions. This effect was particularly marked in women. It was concluded that since this histological feature was an independent prognostic determinant, it should be reported by the pathologist as a guide to the clinician in assessing prognosis in patients with melanoma.