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. 1992 Nov;66(5):856–861. doi: 10.1038/bjc.1992.373

The prognosis of primary and metastasising melanoma. An evaluation of the TNM classification in 2,495 patients.

A C Häffner 1, C Garbe 1, G Burg 1, P Büttner 1, C E Orfanos 1, G Rassner 1
PMCID: PMC1977994  PMID: 1419627

Abstract

The prognostic value of the TNM classifications of the UICC dated 1978 and 1987, was investigated in a population of 2,495 patients who were followed up over the long term. In the case of primary melanoma, Breslow's tumour thickness proved to be the most powerful predictor of patient survival in multivariate analysis, while the significance of Clark's level ranged after that of both localisation of the primary tumour and the sex of the patient. The continuous proportional relationship between tumour thickness and risk of death makes it possible to regrade thickness groups. Grading cutoffs at 1, 2 and 4 millimetres, with no account being taken of depth of invasion, proved to be particularly favourable for a classification in accordance with prognostic criteria. In advanced stages of the disease, the outcome of locoregional and distant metastasis is significantly different; and furthermore in the case of locoregional metastasis, in-transit and satellite metastases exert a significantly better prognosis than regional lymph node involvement. Isolated juxtaregional lymph node metastases occurred primarily or during the course of the observation period in only 19 patients of our group, and, in comparison with visceral metastases, proved to have only an insignificantly better prognosis. For this reason, it would appear meaningful to assign them to a common stage. On the basis of these results, proposals are made for modifications of the TNM classification.

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Selected References

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  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., Soong S. J., Milton G. W., Shaw H. M., McGovern V. J., Murad T. M., McCarthy W. H., Maddox W. A. 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. Ann Surg. 1982 Dec;196(6):677–684. doi: 10.1097/00000658-198212001-00011. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Berdeaux D. H., Meyskens F. L., Jr, Parks B., Tong T., Loescher L., Moon T. E. Cutaneous malignant melanoma. II. The natural history and prognostic factors influencing the development of stage II disease. Cancer. 1989 Apr 1;63(7):1430–1436. doi: 10.1002/1097-0142(19890401)63:7<1430::aid-cncr2820630733>3.0.co;2-g. [DOI] [PubMed] [Google Scholar]
  4. Breslow A. Thickness, cross-sectional areas and depth of invasion in the prognosis of cutaneous melanoma. Ann Surg. 1970 Nov;172(5):902–908. doi: 10.1097/00000658-197011000-00017. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. CUTLER S. J., EDERER F. Maximum utilization of the life table method in analyzing survival. J Chronic Dis. 1958 Dec;8(6):699–712. doi: 10.1016/0021-9681(58)90126-7. [DOI] [PubMed] [Google Scholar]
  6. Cascinelli N., Vaglini M., Bufalino R., Morabito A. BANS. A cutaneous region with no prognostic significance in patients with melanoma. Cancer. 1986 Feb 1;57(3):441–444. doi: 10.1002/1097-0142(19860201)57:3<441::aid-cncr2820570306>3.0.co;2-s. [DOI] [PubMed] [Google Scholar]
  7. Chanda J. J. The clinical recognition and prognostic factors of primary cutaneous malignant melanoma. Med Clin North Am. 1986 Jan;70(1):39–55. doi: 10.1016/s0025-7125(16)30967-1. [DOI] [PubMed] [Google Scholar]
  8. Day C. L., Jr, Lew R. A., Mihm M. C., Jr, Harris M. N., Kopf A. W., Sober A. J., Fitzpatrick T. B. The natural break points for primary-tumor thickness in clinical Stage I melanoma. N Engl J Med. 1981 Nov 5;305(19):1155–1155. doi: 10.1056/NEJM198111053051916. [DOI] [PubMed] [Google Scholar]
  9. Day C. L., Jr, Lew R. A., Mihm M. C., Jr, Sober A. J., Harris M. N., Kopf A. W., Fitzpatrick T. B., Harrist T. J., Golomb F. M., Postel A. A multivariate analysis of prognostic factors for melanoma patients with lesions greater than or equal to 3.65 mm in thickness. The importance of revealing alternative Cox models. Ann Surg. 1982 Jan;195(1):44–49. doi: 10.1097/00000658-198201001-00007. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Drzewiecki K. T., Frydman H., Andersen K., Poulsen H., Ladefoged C., Vibe P. Malignant melanoma. Changing trends in factors influencing metastasis-free survival from 1964 to 1982. Cancer. 1990 Jan 15;65(2):362–366. doi: 10.1002/1097-0142(19900115)65:2<362::aid-cncr2820650231>3.0.co;2-e. [DOI] [PubMed] [Google Scholar]
  11. Johnson O. K., Jr, Emrich L. J., Karakousis C. P., Rao U., Greco W. R. Comparison of prognostic factors for survival and recurrence in malignant melanoma of the skin, clinical Stage I. Cancer. 1985 Mar 1;55(5):1107–1117. doi: 10.1002/1097-0142(19850301)55:5<1107::aid-cncr2820550528>3.0.co;2-c. [DOI] [PubMed] [Google Scholar]
  12. Karakousis C. P., Emrich L. J., Rao U. Tumor thickness and prognosis in clinical stage I malignant melanoma. Cancer. 1989 Oct 1;64(7):1432–1436. doi: 10.1002/1097-0142(19891001)64:7<1432::aid-cncr2820640712>3.0.co;2-m. [DOI] [PubMed] [Google Scholar]
  13. Lee E. T., Desu M. M. A computer program for comparing K samples with right-censored data. Comput Programs Biomed. 1972 Nov;2(4):315–321. doi: 10.1016/0010-468x(72)90019-0. [DOI] [PubMed] [Google Scholar]
  14. Meyskens F. L., Jr, Berdeaux D. H., Parks B., Tong T., Loescher L., Moon T. E. Cutaneous malignant melanoma (Arizona Cancer Center experience). I. Natural history and prognostic factors influencing survival in patients with stage I disease. Cancer. 1988 Sep 15;62(6):1207–1214. doi: 10.1002/1097-0142(19880915)62:6<1207::aid-cncr2820620628>3.0.co;2-a. [DOI] [PubMed] [Google Scholar]
  15. Rogers G. S., Kopf A. W., Rigel D. S., Levenstein M. L., Friedman R. J., Harris M. N., Golomb F. M., Hennessey P., Gumport S. L., Roses D. F. Influence of anatomic location on prognosis of malignant melanoma: attempt to verify the BANS model. J Am Acad Dermatol. 1986 Aug;15(2 Pt 1):231–237. doi: 10.1016/s0190-9622(86)70162-x. [DOI] [PubMed] [Google Scholar]
  16. Salman S. M., Rogers G. S. Prognostic factors in thin cutaneous malignant melanoma. J Dermatol Surg Oncol. 1990 May;16(5):413–418. doi: 10.1111/j.1524-4725.1990.tb00057.x. [DOI] [PubMed] [Google Scholar]
  17. Vincent P. C., Joyce R. M., Croaker G., Young G. A., Milton G. W., McCarthy W. H. Semi-solid cultures of primary melanomas and their correlation with histopathological features. Pathology. 1985 Apr;17(2):360–364. doi: 10.3109/00313028509063780. [DOI] [PubMed] [Google Scholar]

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