Cutaneous malignant melanoma in south-east Scotland

This paper reports a retrospective study of 477 patients with cutaneous malignant melanoma presenting in the south-east of Scotland (lat. 55 degrees-56 degrees N) between 1961 and 1976. The mean annual incidence during the period 1971 to 1976 was 4.6/100 000 with females affected almost twice as often as males. The incidence has probably increased in the last 10 years. The median age at presentation was in the sixth decade in both sexes and 88 per cent of patients had clinical Stage 1 disease when first seen. Primary lesions on the female lower leg accounted for a third of all tumours. Superficial spreading melanoma was the most common growth pattern. The overall five year survival rate was significantly less for males (48 per cent) compared with females (67 per cent). Other factors which had an independent effect on prognosis were the age of the patient, the site of the tumour, its thickness and mitotic rate. The thickness of the primary lesion was the best index of prognosis, with the five year survival rate ranging from 97 per cent for patients with tumours less than 0.5 mm deep to 38 per cent for those with tumours thicker than 3.5 mm. Although the relationship between tumour depth and duration of signs before treatment was not investigated, it seems likely that better survival figures will be achieved more by earlier diagnosis and treatment than by any change in management.