Prognosis of thick cutaneous melanoma of the trunk and extremity
D. Coit, P. Sauven and M. Brennan
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021.
The records of 129 patients with thick cutaneous melanoma of the trunk or
extremity treated at Memorial Sloan-Kettering Cancer Center, New York, NY,
between 1974 and 1984 were reviewed with the aim of defining prognostic
variables. All primary lesions invaded subcutaneous fat, were Clark level
V, or of a Breslow thickness of 4.0 mm or greater. Treatment in all cases
was by wide excision with or without split-thickness skin graft; all
patients underwent regional lymph node dissection. Overall survival rate
for the group was 47% at 5 years and 36% at 10 years. Factors independently
predictive of survival were pathologic negative nodes (71% at 5 years
compared with 28% for pathologic positive nodes) and extremity site (58% at
5 years compared with 33% for truncal site). Patients with node-negative
thick cutaneous melanoma of the extremity had a 5-year survival rate of
82%. Patients with node-positive truncal thick cutaneous melanoma had a
5-year survival rate of only 8%. There was no difference between the 5-year
survival rate of patients with node-negative truncal thick cutaneous
melanoma, 52%, and patients with node-positive thick cutaneous melanoma of
the extremity, 42%. Nearly half of the patients with thick cutaneous
melanoma of the extremity and trunk present with locoregional disease, at a
stage when an aggressive surgical approach is warranted. Prognostic
variables of pathologic nodal status and site identify patients at risk for
early systemic failure.
