Skip to main content
PMC home page
Annals of Surgery logoLink to Annals of Surgery
. 1982 Dec;196(6):677–684. doi: 10.1097/00000658-198212001-00011

A comparison of prognostic factors and surgical results in 1,786 patients with localized (stage I) melanoma treated in Alabama, USA, and New South Wales, Australia.

C M Balch, S J Soong, G W Milton, H M Shaw, V J McGovern, T M Murad, W H McCarthy, W A Maddox
PMCID: PMC1352984  PMID: 7149819

Abstract

Twelve clinical and pathologic parameters were compared in two series of Stage I melanoma patients treated at the University of Alabama in Birmingham, USA (676 patients) and at the University of Sydney in New South Wales, Australia (1,110 patients). Actuarial survival rates were virtually the same at the two institutions over a 25-year follow-up period. The incidence of thin melanomas (less than 0.76 mm) was also similar at both geographic locations (25% vs. 26%). Other similarities of these two patient populations included the following: 1) tumor thickness (Breslow Microstaging). 2) level of invasion (Clark Microstaging), 3) surgical results, 4) sex distribution, and 5) age distribution. The greatest differences between the two patient populations were their 1) anatomic distribution, 2) growth pattern, and 3) incidence of ulceration. The trunk was the most common site of melanoma, and occurred more frequently among Australian patients (37% vs. 28%). A multifactorial analysis (Cox's regression model) was then performed that included a comparison of the two institutions as a variable (Alabama vs. Australia). The dominant prognostic factors (p less than 0.0001) were 1) ulceration, 2) tumor thickness, 3) initial surgical management (wide excision +/- node dissection), 4) anatomic location, 5) pathologic stage (I vs. II), and 6) level of invasion. The benefit of elective lymph node dissection was demonstrated in both series for patients with intermediate thickness melanoma (0.76 to 3.99 mm.) For melanomas ranging from 0.76 to 1.5 mm in thickness, the benefit of node dissection was primarily in male patients. Survival rates for melanoma at the two institutions were not significantly different in the multifactorial analysis, even after adjusting for all other variable. Thus, the biologic behavior of melanoma in these two different parts of the world was virtually the same, with only minor differences that did not significantly influence survival rates. Long-term follow-up exceeding eight to ten years after surgery is critical in the interpretation of these prognostic factors and the surgical results.

Full text

PDF
677

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Balch C. M., Murad T. M., Soong S. J., Ingalls A. L., Halpern N. B., Maddox W. A. A multifactorial analysis of melanoma: prognostic histopathological features comparing Clark's and Breslow's staging methods. Ann Surg. 1978 Dec;188(6):732–742. doi: 10.1097/00000658-197812000-00004. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Balch C. M., Murad T. M., Soong S. J., Ingalls A. L., Richards P. C., Maddox W. A. Tumor thickness as a guide to surgical management of clinical stage I melanoma patients. Cancer. 1979 Mar;43(3):883–888. doi: 10.1002/1097-0142(197903)43:3<883::aid-cncr2820430316>3.0.co;2-v. [DOI] [PubMed] [Google Scholar]
  3. Balch C. M., Soong S. J., Murad T. M., Ingalls A. L., Maddox W. A. A multifactorial analysis of melanoma. II. Prognostic factors in patients with stage I (localized) melanoma. Surgery. 1979 Aug;86(2):343–351. [PubMed] [Google Scholar]
  4. Balch C. M. Surgical management of regional lymph nodes in cutaneous melanoma. J Am Acad Dermatol. 1980 Nov;3(5):511–524. doi: 10.1016/s0190-9622(80)80118-6. [DOI] [PubMed] [Google Scholar]
  5. Balch C. M., Wilkerson J. A., Murad T. M., Soong S. J., Ingalls A. L., Maddox W. A. The prognostic significance of ulceration of cutaneous melanoma. Cancer. 1980 Jun 15;45(12):3012–3017. doi: 10.1002/1097-0142(19800615)45:12<3012::aid-cncr2820451223>3.0.co;2-o. [DOI] [PubMed] [Google Scholar]
  6. Breslow A. Tumor thickness, level of invasion and node dissection in stage I cutaneous melanoma. Ann Surg. 1975 Nov;182(5):572–575. doi: 10.1097/00000658-197511000-00007. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Day C. L., Jr, Mihm M. C., Jr, Lew R. A., Harris M. N., Kopf A. W., Fitzpatrick T. B., Harrist T. J., Golomb F. M., Postel A., Hennessey P. Prognostic factors for patients with clinical stage I melanoma of intermediate thickness (1.51 - 3.39 mm). A conceptual model for tumor growth and metastasis. Ann Surg. 1982 Jan;195(1):35–43. doi: 10.1097/00000658-198201001-00006. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Day C. L., Jr, Sober A. J., Kopf A. W., Lew R. A., Mihm M. C., Jr, Golomb F. M., Hennessey P., Harris M. N., Gumport S. L., Raker J. W. A prognostic model for clinical stage I melanoma of the lower extremity. Location on foot as independent risk factor for recurrent disease. Surgery. 1981 May;89(5):599–603. [PubMed] [Google Scholar]
  9. Day C. L., Jr, Sober A. J., Kopf A. W., Lew R. A., Mihm M. C., Jr, Hennessey P., Golomb F. M., Harris M. N., Gumport S. L., Raker J. W. A prognostic model for clinical stage I melanoma of the upper extremity. The importance of anatomic subsites in predicting recurrent disease. Ann Surg. 1981 Apr;193(4):436–440. doi: 10.1097/00000658-198104000-00007. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Day C. L., Jr, Sober A. J., Lew R. A., Mihm M. C., Jr, Fitzpatrick T. B., Kopf A. W., Harris M. N., Gumport S. L., Raker J. W., Malt R. A. Malignant melanoma patients with positive nodes and relatively good prognoses: microstaging retains prognostic significance in clinical stage I melanoma patients with metastases to regional nodes. Cancer. 1981 Mar 1;47(5):955–962. doi: 10.1002/1097-0142(19810301)47:5<955::aid-cncr2820470523>3.0.co;2-1. [DOI] [PubMed] [Google Scholar]
  11. Eldh J., Boeryd B., Peterson L. E. Prognostic factors in cutaneous malignant melanoma in stage I. A clinical, morphological and multivariate analysis. Scand J Plast Reconstr Surg. 1978;12(3):243–255. doi: 10.3109/02844317809013000. [DOI] [PubMed] [Google Scholar]
  12. McCarthy W. H., Black A. L., Milton G. W. Melanoma in New South Wales: an epidemiologic surgery 1970--76. Cancer. 1980 Jul 15;46(2):427–432. doi: 10.1002/1097-0142(19800715)46:2<427::aid-cncr2820460237>3.0.co;2-e. [DOI] [PubMed] [Google Scholar]
  13. McGovern V. J., Shaw H. M., Milton G. W., Farago G. A. Prognostic significance of the histological features of malignant melanoma. Histopathology. 1979 Sep;3(5):385–393. doi: 10.1111/j.1365-2559.1979.tb03020.x. [DOI] [PubMed] [Google Scholar]
  14. McGovern V. J., Shaw H. M., Milton G. W., McCarthy W. H. Ulceration and prognosis in cutaneous malignant melanoma. Histopathology. 1982 Jul;6(4):399–407. doi: 10.1111/j.1365-2559.1982.tb02737.x. [DOI] [PubMed] [Google Scholar]
  15. Milton G. W., Shaw H. M., Farago G. A., McCarthy W. H. Tumour thickness and the site and time of first recurrence in cutaneous malignant melanoma (stage I). Br J Surg. 1980 Aug;67(8):543–546. doi: 10.1002/bjs.1800670804. [DOI] [PubMed] [Google Scholar]
  16. Milton G. W., Shaw H. M., McCarthy W. H., Pearson L., Balch C. M., Soong S. J. Prophylactic lymph node dissection in clinical stage I cutaneous malignant melanoma: results of surgical treatment in 1319 patients. Br J Surg. 1982 Feb;69(2):108–111. doi: 10.1002/bjs.1800690217. [DOI] [PubMed] [Google Scholar]
  17. Shackford S. R., Virgilio R. W., Peters R. M. Whole blood versus packed-cell transfusions: a physiologic comparison. Ann Surg. 1981 Mar;193(3):337–340. doi: 10.1097/00000658-198103000-00015. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Shaw H. M., McGovern V. J., Milton G. W., Farago G. A., McCarthy W. H. Histologic features of tumors and the female superiority in survival from malignant melanoma. Cancer. 1980 Apr 1;45(7):1604–1608. doi: 10.1002/1097-0142(19800401)45:7<1604::aid-cncr2820450715>3.0.co;2-o. [DOI] [PubMed] [Google Scholar]
  19. Shaw H. M., McGovern V. J., Milton G. W., Farago G. A., McCarthy W. H. Malignant melanoma: influence of site of lesion and age of patient in the female superiority in survival. Cancer. 1980 Dec 15;46(12):2731–2735. doi: 10.1002/1097-0142(19801215)46:12<2731::aid-cncr2820461232>3.0.co;2-2. [DOI] [PubMed] [Google Scholar]
  20. Sim F. H., Taylor W. F., Ivins J. C., Pritchard D. J., Soule E. H. A prospective randomized study of the efficacy of routine elective lymphadenectomy in management of malignant melanoma. Preliminary results. Cancer. 1978 Mar;41(3):948–956. doi: 10.1002/1097-0142(197803)41:3<948::aid-cncr2820410324>3.0.co;2-z. [DOI] [PubMed] [Google Scholar]
  21. Van Der Esch E. P., Cascinelli N., Preda F., Morabito A., Bufalino R. Stage I melanoma of the skin: evaluation of prognosis according to histologic characteristics. Cancer. 1981 Oct 1;48(7):1668–1673. doi: 10.1002/1097-0142(19811001)48:7<1668::aid-cncr2820480732>3.0.co;2-9. [DOI] [PubMed] [Google Scholar]
  22. Veronesi U., Adamus J., Bandiera D. C., Brennhovd I. O., Caceres E., Cascinelli N., Claudio F., Ikonopisov R. L., Javorskj V. V., Kirov S. Inefficacy of immediate node dissection in stage 1 melanoma of the limbs. N Engl J Med. 1977 Sep 22;297(12):627–630. doi: 10.1056/NEJM197709222971202. [DOI] [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES