Clinical and Histopathological Factors in the Prognosis of Cutaneous Malignant Melanoma- An Ambispective Study

Abstract

Introduction: Melanomas are the most dangerous among the different skin cancers, they can arise from a pre-existing lesion or may arise de novo. Among the common skin cancers, melanoma is the most dangerous. It accounts for approximately 75% of all skin cancer-related deaths, although it comprises only 3% of all skin cancers diagnosed each year. The incidence of Cutaneous Malignant Melanoma (CMM) is increasing worldwide faster than any other cancer. Aim: To study the clinical and histological factors in relation to the outcomes among patients diagnosed with the CMM in a tertiary care centre in Southern India. Materials and Methods: This ambispective study was conducted in Kasturba Medical College, Manipal (MAHE), Karnataka, India (tertiary care centre), from June 2001 to June 2016. A total of 87 patients, aged more than 18 years with histopathological evidence of cutaneous malignant melanoma and patients with more than one year of follow-up were enrolled in present study. Data obtained included sex, age at diagnosis, site over the body, histological subtype, Clark’s level, Breslow’s thickness, lymph nodal status (clinical and pathological), treatment received and status at the time of review. Descriptive statistics were presented as mean, median and standard deviation, Chi-square test was used for the analysis of qualitative variables and ‘t’ test was used for continuous variables. Results: The mean age in the present study (N=87) was 57±10 years with maximum cases 32 (36.78%) aged between 61- 70 years, followed by the 22 (25.29%) case aged between 51- 60 years and 18 (20.69%) aged between 41-50 years. Maximum patients, 27 (42.19%) In disease free group and 37 (57.81%) in non disease free group were aged >50 years. A total of 48 (55.17%) males patient and 39 (44.83%) females were included in present study. Out of total, 71 (81.6%) patients had primary lesion on the extremities and 16 (18.40%) patients had primary lesions on the trunk, head and neck. Ulceration was present in total 56 patients. Out of these 56 patients ulceration was present in 34 (60.71%) in non disease free group and in 22 (39.29%) in disease free group. Clark’s level was unknown for 23 patients. Out of 64 patients, in disease free group, maximum patients 11 (78.57%) were in Clark’s level II, while in non disease free group maximum patients 13 (76.47%) were in Clark’s level IV followed by the 12 (63.16%) in Clark’s level III. Maximum cases 7 (63.63%) in disease free group were seen in <1 mm and 7 (41.18%) in 1.01-2 mm group. Conclusion: Significant relation between Clark’s levels and prognosis of the CMM was seen. The study also showed statistically significant association of Breslow’s thickness on prognosis. The common histologial type of malignant melanoma in the study was nodular type.

Keywords

• breslow’s thickness
• clark’s levels
• disease status
• lentigo malignant melanoma
• skin
• superficial spreading melanomas