In a nutshell
The authors analyzed the factors that affect the survival outcomes in the early stages of skin melanoma.
Some background
The occurrence of early stage cutaneous (skin) melanoma is increasing. Tumor thickness (how deep the cancer reaches into the skin) at this stage is usually less than 1 mm. In early stage melanoma patients with localized disease (cancer confined to the original site), tumor thickness is the primary predictive factor to determine patient outcome. Other predictive factors include the rate of tumor growth, ulceration (tumor breaking through skin’s surface) and lymph node metastasis (spreading of cancer to adjacent lymph nodes [tiny, bean-shaped organs that help fight infections]).
To determine if the cancer has spread to the lymph nodes, a procedure known as sentinel lymph node biopsy (SLNB) is carried out. This involves taking a tissue sample for analysis to determine whether the cancer has spread to the nearby lymph nodes.
Further research is needed to adequately determine the role of SLNB in thin melanoma and the factors that affect lymph node metastasis and survival in thin melanoma.
Methods & findings
The authors aimed to determine the factors that predict and affect survival in thin melanoma.
2, 243 patients with thin melanoma were analyzed. The average follow-up time was124 months. All patients had undergone surgery to remove the primary tumor. 35.4% of patients received a SLNB. Patients who had tumor thickness between 0.75 – 1.0 mm, ulceration, high rates of cancer growth, increased regression (unexpected disappearance of tumor) and lymphovascular invasion (presence of cancer in blood vessels or lymphatics) were more likely to undergo SLNB.
Patient survival over a 12-year period was 85.3%. The average time until local recurrence (return of cancer at primary site) was 79 months. Regional (around the original site) recurrence was 78 months and recurrence at a distant part of the body (further away from the original site) was 107 months. The occurrence of distant metastasis was lower than regional recurrence.
In general, patients over 60-years, tumor thickness of more than 0.75 mm, ulceration, lymphovascular invasion, high rates of cancer cell growth and more than 50% regression were associated with worse survival outcomes and cancer recurrence. Each of these factors independently influenced the overall survival (patients who did not die following treatment). All of these factors, except regression, were also associated with the occurrence of lymph node metastasis.
The bottom line
The authors concluded that along with other factors, lymphovascular invasion and regression should be included as predictors of survival outcome in thin melanoma. They also suggested that the staging system of melanoma should be revised to include these factors.
Published By :
Journal of clinical oncology
Date :
Jul 07, 2014
