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Melanin production:
Seven of the cases were felt to show little or no melanin production by the tumor cells. When compared to the other cases with melanin production by tumor cells, these seven cases generally showed a worse outcome.
In the category of little melanin production, there were 7 patients. There were no 5 year survivors with no subsequent disease. There was one 5 year survivor with subsequent disease. For one patient, outcome was good. For six patients, outcome was poor.
In the category of heavier melanin production, there were 31 cases. There were 8 survivors with no subsequent evidence of disease. There were 2 survivors with subsequent evidence of disease. For 10 patients, outcome was good; for 11 patients, outcome was poor, and for 3 patients, outcome was indeterminate. For seven patients, follow-up was poor.
Atypia:
The cytologic features of the tumor cells was studied; the cases were graded as having moderate, moderately severe, or severe atypia. An additional category was characterized as severe atypia with focal moderate atypia.
In the moderate category, there were 2 patients. One patient was a 5 year survivor with no subsequent evidence of disease. For the 2 patients, outcome was good.
In the moderate to moderately severe category, there were 4 patients. There was one 5 year survivor with no subsequent evidence of disease; there was one 5 year survivor with subsequent evidence of disease. For one patient, outcome was good; for one patient, outcome was poor; for one patient, outcome was indeterminate, and for one patient, follow-up was poor.
In the severe category, there were 27 patients. There were four 5 year survivors with no subsequent evidence of disease; there were two 5 year survivors with subsequent evidence of disease. Six patients had a good outcome; 15 had a poor outcome; 2 had an indeterminate outcome; and 4 patients had poor follow-up.
In the severe category with focal moderate atypia, there were 3 patients. One 5 year survivor had no subsequent evidence of disease. For one patient, the outcome was good, and for 2 patients, follow-up was poor.
While the total number of patients whose tumors do not show generalized severe atypia was small, these patients did show overall better outcome (increased % 5 year survivor without recurrence; total 5 year survival; good outcome; decreased % poor outcome).
Ulceration:
Eight patients showed no area of ulceration on the slides reviewed, and generally showed better outcome. However, these patients tended to show lower Breslow measurements than the other patients (mean Breslow measurement of 7 cases = 2.96 mm while the other patients’ measurement was equal to, or greater than, 2.61 mm; for 4 cases, the measurement was equal to, or less than, 1.80 mm). Outcome is listed below:
There were 8 patients without ulceration. There were four 5 year survivors with no subsequent evidence of disease; there were two 5 year survivors with subsequent evidence of disease. For 4 patients, outcome was good; for 3 patients, outcome was poor; for one patient, follow-up was poor.
Correlations in patients showing unexpected outcome:
The above mentioned microscopic observations are subjective, but do show some correlation with patient outcome; the usefulness of the features, if considered independently from Breslow’s measurement, is uncertain. As noted above, a few patients show eventual outcomes which were contrary to what might be expected by Breslow measurements.
One patient had a 5 year survival in spite of Breslow measurement of 8.00 mmm. This patient’s tumor showed severe atypia, mild inflammation, and focal ulceration, all of which would indicate worse prognosis, and would not predict a tendency for good outcome (as actually occurred). Lymph node status was unknown. This patient received perfusion therapy (following excision).
One patient died of melanoma after one year, 7 months in spite of a relatively low measurement (1.80 mm). This patient’s tumor showed mild inflammation, and severe atypia, both of which might have suggested possible poor outcome. However, the patient’s tumor did not show ulceration. Lymph nodes from this patient were uninvolved by tumor. The patient had a poor outcome in spite of negative lymph nodes. This patient received regional perfusion (along with excision, and node dissection).
In addition to above observations, an estimation of mitotic rate (not as a formal mitotic count) was made, but did not show good correlation with outcome. Also an attempt was made to measure tumor width; this was technically difficult. Data obtained was used to calculate a product of tumor height X width, but these values did not show good correlation with outcome.
For 16 patients, lymph nodes were involved. For 11 patients, nodal status was unknown. Five lesions involved a hand. The youngest patient was 34; the oldest 83. Most of the patients were older than 50. The interval from diagnosis to death was as short as 20 days (death due to wide-spread metastases).
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