Exophytic (pedunculated) malignant melanoma--Cleveland Clinic experience

Since few cases of exophytic malignant melanoma have been reported, their nature, history, and prognosis have been uncertain and controversial. We report 26 cases followed at the Cleveland Clinic from 1969 to 1975. Twenty men and 6 women ranging in age from 19 to 65 years were followed. There were 16 deaths, 3 patients are alive with lymph node metastases, and 3 patients are alive with distant metastases, for a 2-year disease-free survival of 15% and 5-year survival of 33%. All patients had lesions of either Clark level III, IV, or V with no correlation to survival. All lesions were 2 mm or more in thickness. A 44% disease-free survival was found for lesions 2 to 3 mm in thickness and no disease-free survival for lesions thicker than 3 mm. Our findings support the concept that exophytic malignant melanomas have increased malignant potential. We believe all malignant melanomas should be classified according to both Clark levels and Breslow's micrometer thickness measurements.