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George I. Salti, MD; Ashwin Kansagra, MD; Michael A. Warso, MD; Salve G. Ronan, MD; Tapas K. Das Gupta, MD, PhD, DSc

Arch Surg. 2002;137:291-295.

Background  Patients with T4 N0 M0 melanoma are considered at high risk for having occult metastases, and adjuvant therapy is usually recommended.

Hypothesis  Long-term survival in patients with thick melanoma is not universally poor.

Design  A retrospective study.

Setting  University teaching hospital.

Patients  We evaluated clinical node-negative thick (4.0 mm) melanoma in 151 patients who received their primary definitive surgical treatment in our department. None of these patients received any adjuvant therapy.

Results  Median follow-up was 44 months; median thickness, 5.5 mm. Median overall (OS) and disease-free survivals (DFS) were 70 (5-year survival, 52%) and 51 months (5-year survival, 47%), respectively. Patients with node-positive disease faired significantly worse than did those with node-negative disease. Median OS and DFS for patients with node-positive disease were 49 and 32 months (5-year survival, 35%), respectively, compared with 209 (5-year survival, 61%) and 165 months (5-year survival, 56%), respectively, for patients with node-negative disease. Similarly, OS and DFS were significantly lower when the primary tumor had at least 5 mitoses/mm² or was located in the head and neck region. After multivariate analysis, status of the lymph nodes was the most predictive variable for OS and DFS.

Conclusions  The thickness of melanoma, by itself, should not be used as a criterion for adjuvant therapy. Other prognostic factors should be considered.

From the Departments of Surgical Oncology (Drs Salti, Kansagra, Warso, and Das Gupta) and Pathology (Dr Ronan), College of Medicine, University of Illinois at Chicago.
Dr Ronan is deceased.

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