+ Site Statistics
+ Search Articles
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ PDF Full Text
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Translate
+ Recently Requested

Regression does not predict nodal metastasis or survival in patients with cutaneous melanoma

Regression does not predict nodal metastasis or survival in patients with cutaneous melanoma

American Surgeon 77(8): 1009-1013

Controversy exists regarding the prognostic implications of regression in patients with cutaneous melanoma. Some consider regression to be an indication for sentinel lymph node (SLN) biopsy because regression may result in underestimation of the true Breslow thickness. Other data support regression as a favorable prognostic indicator, representing immune system recognition of the primary tumor. This analysis was performed to determine whether regression predicts nodal metastasis, disease-free survival (DFS), or overall survival (OS). Post hoc analysis was performed of a multicenter prospective randomized trial that included patients aged 18 to 70 years with cutaneous melanomas 1 mm or greater Breslow thickness. All patients underwent SLN biopsy; those with tumor-positive SLN underwent completion lymphadenectomy. Kaplan-Meier analysis of survival, univariate analysis, and multivariate analysis were performed. A total of 2220 patients (261 with regression; 1959 without regression) were included in this analysis with a median follow-up of 68 months. Patients with regression were more likely to be male, older than 50 years old, and have lower median Breslow thickness, superficial spreading histologic subtype, and a nonextremity anatomic location (P < 0.05 in all cases). Regression was not significantly associated with Clark level, ulceration, lymphovascular invasion, number of SLNs removed, or SLN metastasis. On multivariate analysis, factors independently predictive of DFS included Breslow thickness, ulceration, and SLN status (P < 0.05 in all cases); the same factors along with age, gender, and anatomic tumor location were significantly associated with OS (P < 0.05 in all cases). Regression was not significantly associated with DFS (risk ratio [RR], 0.94; 95% confidence interval [CI], 0.67-1.27; P = 0.68) or OS (RR, 1.01; 95% CI, 0.76-1.32; P = 0.93). These data suggest that regression is not a significant prognostic factor for patients with cutaneous melanoma and should not be used to guide clinical decision-making for such patients.

(PDF emailed within 1 workday: $29.90)

Accession: 055446706

Download citation: RISBibTeXText

PMID: 21944515

Related references

The factors of disease-free survival in patients with nodal metastases of cutaneous melanoma. Voprosy Onkologii 50(4): 426-429, 2004

Patients with lymphatic metastasis of cutaneous malignant melanoma benefit from sentinel lymphonodectomy and early excision of their nodal disease. European Journal of Cancer 40(2): 212-218, 2004

Histological lymphovascular invasion is associated with nodal involvement, recurrence, and survival in patients with cutaneous malignant melanoma. International Journal of Dermatology (): -, 2016

Dramatic regression of cutaneous, nodal, and visceral melanoma metastases. Journal of the American Academy of Dermatology 65(3): 665-666, 2011

Tumor Infiltrating Lymphocytes (TILs) May be Only an Independent Predictor of Nodal Involvement but not for Recurrence and Survival in Cutaneous Melanoma Patients. Cancer Investigation 35(8): 501-505, 2017

What is the best way to predict disease-free survival after preoperative radiochemotherapy for rectal cancer patients: tumor regression grading, nodal status, or circumferential resection margin invasion?. Journal of Clinical Oncology 24(8): 1319; Author Reply 1320-1, 2006

Does mitotic rate predict sentinel lymph node metastasis or survival in patients with intermediate and thick melanoma?. American Journal of Surgery 200(6): 759-63; Discussion 763-4, 2011

Clinical and pathologic factors associated with distant metastasis and survival in patients with thin primary cutaneous melanoma. Annals of Surgical Oncology 19(6): 1782-1789, 2012

Spontaneous regression of cutaneous melanoma with subsequent metastasis. Journal of Oral and Maxillofacial Surgery 60(5): 588-591, 2002

Regression of a cutaneous melanoma metastasis after intralesional cidofovir. Melanoma Research 13(2): 205-206, 2003

Spontaneous regression of subcutaneous metastasis of cutaneous melanoma. Plastic and Reconstructive Surgery 90(6): 1073-1076, 1992

Functional Variants in Notch Pathway Genes NCOR2, NCSTN, and MAML2 Predict Survival of Patients with Cutaneous Melanoma. Cancer Epidemiology, Biomarkers & Prevention 24(7): 1101-1110, 2016

Improved survival after lymphadenectomy for nodal metastasis from an unknown primary melanoma. Journal of Clinical Oncology 26(4): 535-541, 2008

Cutaneous malignant melanoma in West Yorkshire: II. A prospective study of recurrence and prediction of lymph nodal metastasis. British Journal of Cancer 50(1): 35-43, 1984

Therapeutic and clinico-pathological factors in the survival of 1,469 patients with primary cutaneous malignant melanoma in clinical stage I. A multivariate regression analysis. Virchows Archiv. A, Pathological Anatomy and Histopathology 408(2-3): 249-258, 1985