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What Is the Prognostic Significance of Incipient Ulceration in Melanoma?

Patients with nonulcerated tumors have better survival than incipiently ulcerated cases in univariable analysis

By Dermsquared Editorial Team | November 01, 2023

WEDNESDAY, Nov. 1, 2023 -- Patients with nonulcerated cutaneous melanoma tumors have better survival than those with incipiently ulcerated tumors in univariable analyses, but no differences are seen in adjusted analyses, according to a study published online Nov. 1 in JAMA Dermatology.

Elizabeth C. Paver, M.B.B.S., from The University of Sydney, and colleagues examined the prognostic significance of incipient ulceration in cutaneous melanoma in a case-control study consisting of resected primary cutaneous melanomas diagnosed between 2005 and 2015. Slides were reviewed by pathologists experienced in the diagnosis of melanocytic lesions and were classified as cases (incipient ulceration) and controls (ulcerated or nonulcerated). The cohort consisted of 40 cases of incipiently ulcerated melanoma, 80 nonulcerated controls, and 80 ulcerated controls.

The researchers found a significant difference in median Breslow thickness between cases and controls (2.8, 1.0, and 5.3 mm for incipient cases, nonulcerated, and ulcerated melanomas, respectively). The median tumor mitotic rate was 5.0, 1.0, and 9.0 per mm2 in incipiently ulcerated cases, nonulcerated controls, and ulcerated controls, respectively. Compared with patients with incipient ulceration, those with nonulcerated tumors had significantly better overall survival and recurrence-free survival (RFS; hazard ratios, 0.49 and 0.37, respectively). Compared with incipiently ulcerated cases, the RFS was significantly worse in ulcerated tumors (hazard ratio, 1.67). No significant differences were seen in clinical outcomes between cases and controls after adjustment for pathological factors.

"Moving forward, pathologists should comment on the presence of incipient ulceration in pathology reports of primary melanomas, so that related data on this feature can continue to be collected," the authors write.

Several authors disclosed ties to the pharmaceutical industry.


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