Cutaneous thick melanoma. Prognosis and treatment
S. Schneebaum, H. A. Briele, M. J. Walker, J. Greager, D. K. Wood, S. G. Ronan, M. K. Patel and T. K. Das Gupta
Among proponents of elective lymph node dissection (ELND) for clinical
stage I melanoma, controversy exists as to whether there is an upper limit
of tumor thickness beyond which ELND should not be considered. We reviewed
169 patients with clinical stage I and II melanoma that was greater than or
equal to 3.0 mm thick and who were treated at the University of Illinois
Hospital, Chicago. Of 139 patients with clinical stage I disease, 117
underwent ELND. Five- and ten-year survival rates were 55.7% and 48.9%,
respectively. Multifactorial analysis demonstrated that anatomical
location, level, pathologic stage, and ulceration were the best predictors
of survival. Thickness did not emerge as a significant variable. Our
findings do not support basing treatment decisions, eg, ELND in this group
of patients, solely on the thickness of the primary tumor. We continue to
recommend ELND in patients with either intermediate or thick melanomas.
