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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 6/2012

01-06-2012 | Melanomas

Clinical and Pathologic Factors Associated with Distant Metastasis and Survival in Patients with Thin Primary Cutaneous Melanoma

Authors: Rajmohan Murali, MBBS, MD, FRCPA, Lauren E. Haydu, BSCHE, MIPH, Georgina V. Long, MBBS, PhD, FRACP, Michael J. Quinn, MBBS, FRACS, Robyn P. M. Saw, MBBS, FRACS, Kerwin Shannon, MBBS, FRACS, Andrew J. Spillane, MD, FRACS, Jonathan R. Stretch, MBBS, DPhil, FRACS, Richard F. Kefford, MBBS, FRACP, John F. Thompson, MBBS, MD, FRACS, FACS, Richard A. Scolyer, MBBS, MD, FRCPA, FRCPath

Published in: Annals of Surgical Oncology | Issue 6/2012

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Abstract

Background

Approximately 3–5% of patients with thin (≤1 mm) cutaneous melanomas develop distant metastases. We sought to identify clinical and pathologic factors associated with distant metastasis and survival in a large number of patients with thin melanoma treated at a single institution.

Methods

We identified patients with a single invasive melanoma ≤1 mm in thickness diagnosed between January 1983 and December 2003 who developed distant metastasis (cases), and matched patients with no recorded recurrence during follow-up (control subjects). Cases and control subjects were matched for age, sex, and year of primary melanoma diagnosis. Associations of clinical and pathologic parameters with distant metastasis-free survival and melanoma-specific survival were analyzed.

Results

A total of 178 cases and 178 control subjects were identified. Factors associated with development of distant metastasis were: increasing Breslow thickness (P < 0.001), increasing Clark level of invasion (P < 0.001), increasing mitotic rate (P = 0.001), ulceration (P = 0.025), and American Joint Committee on Cancer T subcategory (P < 0.001). Multivariable models including Breslow thickness (but not Clark level) showed that factors independently associated with poorer distant metastasis-free survival were increasing age [hazard ratio (HR) 1.01, 95% confidence interval (CI) 1.00–1.02]; increasing Breslow thickness (HR 3.21, 95% CI 1.73–5.94, and HR 3.77, 95% CI 2.11–6.74 for 0.51–0.75 mm and 0.76–1.00 mm, respectively, compared with 0.01–0.50 mm); ulceration (HR 1.87, 95% CI 1.14–3.06) and mitotic rate (HR 1.13, 95% CI 1.05–1.21). Similar associations with melanoma-specific survival were found.

Conclusions

Clinical and pathologic predictors of distant metastasis and survival identified in this large study of patients with thin primary cutaneous melanomas will enable more accurate stratification of risk of distant metastasis and poor survival in such patients, and will assist in formulating clinical management and follow-up regimens based on the level of risk.
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Metadata
Title
Clinical and Pathologic Factors Associated with Distant Metastasis and Survival in Patients with Thin Primary Cutaneous Melanoma
Authors
Rajmohan Murali, MBBS, MD, FRCPA
Lauren E. Haydu, BSCHE, MIPH
Georgina V. Long, MBBS, PhD, FRACP
Michael J. Quinn, MBBS, FRACS
Robyn P. M. Saw, MBBS, FRACS
Kerwin Shannon, MBBS, FRACS
Andrew J. Spillane, MD, FRACS
Jonathan R. Stretch, MBBS, DPhil, FRACS
Richard F. Kefford, MBBS, FRACP
John F. Thompson, MBBS, MD, FRACS, FACS
Richard A. Scolyer, MBBS, MD, FRCPA, FRCPath
Publication date
01-06-2012
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 6/2012
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-012-2265-y

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