title: Histological ulceration as a prognostic factor in cutaneous melanoma: a study of 423 cases in Spain.
abstract: BACKGROUND
  Histological ulceration in cutaneous melanoma carries a high risk of metastasis and has a poor prognosis. However, some epidemiological and survival studies of patients with cutaneous melanoma do not consider histological ulceration as one of the main prognostic factors.
  
  
  METHODS
  Epidemiological, clinical, histological and survival characteristics of all patients diagnosed with cutaneous melanoma over a 10-year period (1994- 2003) were retrospectively analysed.
  
  
  RESULTS
  Ulcerated melanoma was observed in 77 of 423 patients (18.2%). Ulceration was significantly associated with male sex, deeper tumour thickness, positive sentinel lymph node biopsy and metastasis (p<0.001). Histological ulceration indicates a high relative risk (RR) of death from melanoma (RR 9.41; 95% CI 4.52-19.59) and a significant risk of metastasis (RR 5.72; 95% CI 3.56-9.19) (p<0.001).
  
  
  CONCLUSIONS
  Histological ulceration is associated with lower overall survival and disease-free survival in patients with cutaneous melanoma. Presence of ulceration must be included in the clinical history of patients with melanoma to ensure a careful diagnostic work-up and follow-up.
authors.affiliation: Department of Dermatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain. jaavilesizquierdo@gmail.com
authors.forename: José Antonio
authors.initials: JA
authors.lastname: Avilés-Izquierdo
authors.forename: Pablo
authors.initials: P
authors.lastname: Lázaro-Ochaita
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008545:Melanoma / Q000150:complications* / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000150:complications* / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology; D012883:Skin Ulcer / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology; D013030:Spain / Q000453:epidemiology; D016019:Survival Analysis