Prognostic stratification of ulcerated melanoma: not only the extent matters.
OBJECTIVE
For patients with melanoma, ulceration is an important prognostic marker and interestingly also a predictive marker for the response of adjuvant interferon. A consensual definition and accurate assessment of ulceration are therefore crucial for proper staging and clinical management. We evaluated the prognostic impact of the extent and type of ulceration and the epidermal involvement theoretically preceding it (consumption of epidermis and cleft formation) or seen subsequent to the inflammation (reepithelialization and reactive epidermal hyperplasia), aiming for better prognostic stratification of ulcerated lesions.


METHODS
From H&E-stained sections, the status (presence vs absence), extent (percentage of the total tumor length), and type (infiltrative vs attenuative) of ulceration and epidermal involvement were evaluated from 385 patients with cutaneous melanoma.


RESULTS
The presence of ulceration (hazard ratio [HR], 1.83), an attenuative type of ulceration (HR, 3.02), and excessive ulceration (HR, 3.57) were independent predictors of poor melanoma-specific survival. Further subdivision of minimal/moderate ulceration showed independent prognostic value only for lesions with epidermal involvement of the surrounding epidermis (HR, 1.78).


CONCLUSIONS
The extent and type of ulceration and involvement of the surrounding epidermis provided more accurate prognostic information than the mere absence or presence and may be useful markers allowing better stratification of ulcerated lesions.
From the Department of Pathology, Department of Oncology, Plastic Surgery Research Unit, Department of Plastic Surgery, and mariboen@rm.dk.
Marie L
ML
Bønnelykke-Behrndtz
Department of Oncology.
Henrik
H
Schmidt
The Finsens Laboratory, Rigshospital, and Biotech and Research Innovation Center (BRIC), University of Copenhagen, Copenhagen, Denmark;
Ib J
IJ
Christensen
Plastic Surgery Research Unit, Department of Plastic Surgery, and.
Tine E
TE
Damsgaard
Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark;
Holger J
HJ
Møller
Department of Oncology, Odense University Hospital, Odense, Denmark; and.
Lars
L
Bastholt
Department of Pathology, Herlev Hospital, Herlev, Denmark.
Peter H
PH
Nørgaard
From the Department of Pathology.
Torben
T
Steiniche
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008545:Melanoma / Q000401:mortality / Q000473:pathology*; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000401:mortality / Q000473:pathology*; D014456:Ulcer / Q000401:mortality / Q000473:pathology*; D055815:Young Adult
Consumption of epidermis; Extent; Melanoma; Prognosis; Reactive epidermal hyperplasia; Type; Ulceration