title: Outcomes and prognostic factors in nodular melanomas.
abstract: BACKGROUND
  The nodular subtype of cutaneous melanoma has a more pronounced vertical phase and less of a radial growth phase compared with other histologic subtypes. This study was performed to determine prognostic factors and outcomes for nodular melanomas.
  
  
  METHODS
  A post hoc analysis of a prospective clinical trial was performed in all patients with nodular histologic subtype. Univariate and multivariate analyses of factors associated with disease-free survival (DFS), overall survival (OS), and local and in-transit recurrence-free survival (LITRFS) were performed. Kaplan-Meier survival analyses were performed.
  
  
  RESULTS
  There were 736 patients available for analysis, and 189 (25.7%) were sentinel lymph node (SLN) positive. Breslow thickness of ≥2.3 mm, presence of ulceration, nonextremity tumor location, positive SLN, and non-SLN-positive status were independent risk factors for worse OS and DFS. Kaplan-Meier analysis demonstrated that ulceration predicted worse OS and DFS in all nodular melanoma patients, and in both SLN-positive and -negative subsets. The presence of ulceration and a positive SLN together predicted significantly worse DFS and OS.
  
  
  CONCLUSIONS
  The most important risk factors that determine prognosis in nodular melanomas are SLN status and ulceration. The presence of both a positive SLN and ulceration significantly affect DFS and OS, and to a lesser degree LITRFS.
authors.affiliation: Division of Surgical Oncology, Department of Surgery, University of Louisville, Louisville, KY 40202, USA.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Egger
authors.forename: Erik M
authors.initials: EM
authors.lastname: Dunki-Jacobs
authors.forename: Glenda G
authors.initials: GG
authors.lastname: Callender
authors.forename: Amy R
authors.initials: AR
authors.lastname: Quillo
authors.forename: Charles R
authors.initials: CR
authors.lastname: Scoggins
authors.forename: Robert C G
authors.initials: RC
authors.lastname: Martin
authors.forename: Arnold J
authors.initials: AJ
authors.lastname: Stromberg
authors.forename: Kelly M
authors.initials: KM
authors.lastname: McMasters
mesh_terms: D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008207:Lymphatic Metastasis; D008297:Male; D008545:Melanoma / Q000473:pathology* / Q000556:secondary / Q000601:surgery*; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D021701:Sentinel Lymph Node Biopsy; D012878:Skin Neoplasms / Q000473:pathology* / Q000601:surgery*; D012883:Skin Ulcer / Q000473:pathology; D016896:Treatment Outcome