Cutaneous Melanoma: Prognostic Factors
Authors: Jade Homsi, MD, Mohammed Kashani-Sabet, MD, Jane L. Messina, MD, Adil Daud, MD
Abstract
Background: Recent data have changed our views of prognostic factors in cutaneous melanoma. While some newer methods have yielded better prognostic information, some insights have evolved as a result of large-scale population-based analyses.
Methods: We review current data on several different prognostic factors and divide these factors according to their application in localized primary melanoma or metastatic melanoma. For each prognostic factor, the level of evidence supporting its use and its applicability to clinical practice are considered.
Results: For localized primary melanoma, the dominant predictors of survival include lesion thickness, ulceration, and lymph node involvement. Factors such as age, sex, anatomic location, and satellite/in-transit lesions are important in localized melanoma. Factors currently being investigated are tumor vascularity, vascular invasion, mitotic rate, tumor regression, and tumor-infiltrating lymphocytes. For metastatic melanoma, the most important prognostic factors are site of metastases and the presence of elevated serum lactic dehydrogenase. The value of these prognostic factors to clinicians caring for melanoma patients is discussed.
Conclusions: A better understanding of prognostic factors in cutaneous melanoma has evolved over the last decade, allowing oncologists to provide appropriate treatment for their patients. Many of the prognostic factors are interrelated. In the near future, it is expected that several molecular genetic factors will provide more insight into the prognosis of patients with melanoma.
Introduction
In 2005, an estimated 59,580 Americans will be diagnosed with cutaneous melanoma and 7,700 will die of the disease.[1] The Surveillance, Epidemiology, and End Results (SEER) Program reported an increase of more than 600% in the diagnosis of cutaneous melanoma from 1950 to 2000.[2]
In 2002, the American Joint Committee on Cancer (AJCC) approved a new version of the melanoma staging system.[3,4] The changes were validated with an analysis of prognostic factors that involved 17,600 patients with melanoma.[4] The revised system includes the following features: (1) lesion thickness, presence or absence of ulceration but not level of invasion are the dominant predictors of survival in patients with localized melanoma, (2) the number of metastatic lymph nodes rather than their dimensions and the differentiation of microscopic vs macroscopically involved nodes, (3) satellite metastases around a primary melanoma and in-transit metastases were merged into a single staging entity that is grouped into stage III disease, (4) staging information gained from lymphatic mapping and sentinel node biopsy, and (5) for patients with metastatic disease, the site of distant metastases and the serum lactic dehydrogenase level. However, other factors not included in the revised staging system may alter prognosis, survival, and treatment (Table 1).[5] This review addresses both clinical and histologic factors related to outcomes in cutaneous melanoma.
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