Exophytic (pedunculated) malignant melanoma--Cleveland Clinic experience

Area of Science:

• Dermatology
• Oncology
• Pathology

Background:

• Exophytic malignant melanoma (EMM) cases are rare, leading to uncertainty regarding their behavior and prognosis.
• Previous understanding of EMM's clinical characteristics and outcomes has been limited and debated.

Purpose of the Study:

• To investigate the nature, history, and prognosis of exophytic malignant melanoma.
• To analyze survival rates and prognostic factors in a cohort of EMM patients.

Main Methods:

• Retrospective analysis of 26 exophytic malignant melanoma cases treated at Cleveland Clinic (1969-1975).
• Evaluation of patient demographics, lesion characteristics (Clark levels, Breslow thickness), and survival data.
• Correlation of clinical and pathological features with patient outcomes, including disease-free survival and overall survival.

Main Results:

• A 2-year disease-free survival of 15% and a 5-year survival of 33% were observed.
• Lesions with Breslow thickness of 2-3 mm showed a 44% disease-free survival.
• Lesions thicker than 3 mm had no disease-free survival, irrespective of Clark level (III-V).

Conclusions:

• Exophytic malignant melanomas demonstrate a higher malignant potential compared to typical melanomas.
• Accurate classification using both Clark levels and Breslow micrometer thickness is crucial for predicting melanoma prognosis.
• Standardized staging incorporating thickness is recommended for all malignant melanomas.