Melanoma Prognosis

Melanoma prognosis

     Melanoma remains a challenge for the clinician, his main objective being the detection and the surgical excision as early as possible, the tumor thickness remaining the most important melanoma prognosis factor for primary cutaneous melanoma.

     Despite the progress of new forms of adjuvant therapy in advanced forms of melanoma, the therapeutic results are weak, and the metastatic melanoma prognosis is precarious.

     At least 20% of the people diagnosed with melanoma will develop this disease at an advanced level and they will die within the next 5 years after the diagnosis.

     All epidemiological studies suggest that prevention, early clinical detection, targeted therapies, is the base of the vital prognosis improvement of melanoma.

     Early diagnosis and surgical excision of melanoma in situ or early invasive is curative for most patients.

     Where melanoma was confirmed histopathologically, a proper documentation is required for staging melanoma and for determining the optimal treatment and prognosis.

The following clinical and laboratory explorations are indicated:

• blood tests: blood count, LDH, TGO, TGP,
• palpation of regional lymph node area
• the group or groups ultrasound of regional lymph nodes for melanoma

     Numerous studies have attempted to identify the clinical and histological prognostic factors significant for melanoma, the majority thinking that the thickness of the tumor is the most important prognostic factor for melanoma stage I and II.

Prognostic factors for melanoma stage I and II:

• the thickness of the tumor (the Breslow index) - is the most important predictor factor of survival in primary cutaneous melanoma, being inversely proportional with survival. Thickness is proportional to the percentage of recurrences and deaths and inversely proportional to the level of healing.
• the ulceration of the tumor - is amended by destroying the epidermis by the tumor cells. This is the second most important prognostic factor, being strongly correlated with survival, but, unfortunately, is an unfavorable melanoma prognosis.

     The following prognostic factors, significantly correlated with survival although they have not been included in the new staging of melanoma since 2002, proposed by AJCC (American Joint Committee on Cancer), being considered weak prognostic factors.

• Sex - in all studies, women have a higher survival rate than men. The survival of patients with melanoma after 5 years is 77.6% for women and 58.7% for men.
• Location of tumor - There is a correlation between the place and the thickness of melanoma, the melanomas located on the upper and lower limbs having a thickness less than those located in the head, torso and neck. The locations with unfavorable melanoma prognosis for survival are: trunk, head, neck, location, palms.
• Age - is regarded as an individual prognostic factor in many studies, but in these studies are not being taken into consideration the ulceration, the mitotic index, the prognostic index, TIL (tumor infiltrating limphocytes). Advanced age correlated with decreased immunity, would promote a more rapid development of the disease.
• The regression of tumor pathology - assessment is difficult, histological tumor regression corresponds to some well-defined histological criteria. The presence of histological signs of regression is considered as an unfavorable prognostic sign.
• The intra-tumoral lymphocytic infiltration - would favorably influence the prognosis of melanoma.
• The histological type. Three histological subtypes of MM are associated with an unfavorable prognosis: nodular melanoma, amelanotic and unclassified melanoma. Unfavorable prognosis associated with these subtypes would disappear after the adjustment for tumor thickness.
• The presence of microscopic satellite deposits - makes the prognosis of melanoma worse.

Prognostic factors for Stage III Melanoma:

     The presence of regional lymph node metastasis is a grave prognosis for patients that will have survival of 5 years, of approximately 37% and 32% in 10 years. Patients with nodal micro metastasis - clinical stage I and II have a survival rate considerably higher than those in clinical stage III.

Prognosis factors for stage IV melanoma:

     Occurrence of distant metastasis determines an average survival of approximately 6 months. There are considered significant prognostic variable the number of metastases, the possibility of surgical resection, remission duration, the location of metastases.

     Although there have been many advances in the management of melanoma, the only current standard treatment for melanoma is the early diagnosis and the surgical excision of the tumor.