Effect of morphological prognostic factors on long-term treatment results in patients with head and neck skin melanoma

Introduction. Prognosis of patients with localized primary cutaneous melanoma depends on various clinical and pathomorphological aspects. The latest ones are the Breslow depth, Clark invasion, ulceration and mitoses in primary tumor. All of this prognostic features have been studied and discussed during last 30 years. The analyses of the prognostic value of this factors is being continued till nowadays, and that is the main idea of our current study.

The aim of our study is to determine the influence of pathomorphological factors on long-term treatment results in patients with primary head and neck cutaneous melanoma.

Materials and methods. 174 patients with localized primary head and neck cutaneous melanoma were included (were considered for the analysis) (1995–2014). All the patients were considered for Breslow depth (T), Clark invasion, and ulceration using archived pathomorphological tissue samples. The proliferative tumor activity (mitotic rate) was determined in 24 cases with tumor with tumor thickness less than 1.0 mm.

Results. Recurrence-free survival according to ulceration and N0 correlated with long-term treatment results. So, 5-year survival was worse in group with ulceration – 51,8 ± 5,9 % rather than group without ulceration – 69,5 ± 6,4% (р = 0,046). Recurrence-free survival according to Clark invasion and N0 correlated with long-term treatment results and worsened with growth of invasion level. So, 5-year survival in I level group was 100 % versus 27,8 ± 9,4 % in V level group (р = 0,00014). Recurrence-free survival according to mitotic rate did not correlate with long-term treatment results. So, 5-year survival was 79,5 ± 13,0 % and 81,8 ± 11,6 % respectively.

Conclusions. Ulceration of the primary tumor is a factor affecting the rate of regional metastases, which subsequently leads to decrease in relapse-free survival. Also, a direct relation exists between increased rate of regional and distant metastases and increased Clark level of invasion. Mitotic index has a certain effect on the rate of regional metastases, but it doesn’t manifest in analysis of long-term results. Supposedly, this factor is not “strong” enough.

1. Breslow A. Thickness, cross sectional areas and depth of invasion in the prognosis of cutaneous melanoma. Ann Surg 1970;172:902–8. PMID: 5477666

2. Balch C.M., Buzaid A.C., Soong S.-J. et al. Final version of the American Joint Committee on Cancer Staging System for Cutaneous Melanoma. J Clin Oncol 2001;19:3635–48. DOI: 10.1200/JCO.2001.19.16.3635. PMID: 11504745

3. Balch C.M., Buzaid A.C., Soong S.-J. et al. New TNM melanoma staging system: linking biology and natural history to clinical outcomes. Semin Surg Oncol 2003;21:43–52. DOI: 10.1002/ssu.10020. PMID: 12923915

4. Azzola M.F., Shaw H.M., Thompson J.F. et al. Tumor mitotic rate is a more powerful prognostic indicator than ulceration in patients with primary cutaneous melanoma. Cancer 2003;97:1488–98. DOI: 10.1002/cncr.11196. PMID: 12627514

5. McGovern V.J., Shaw H.M., Milton G.W., Farago G.A. Prognostic significance of the histological features of malignant melanoma. Histopathology 1979;3:385–93. PMID: 488922

6. Francken A.B., Shaw H.M., Thompson J.F. et al. The prognostic importance of tumor mitotic rate confirmed in 1317 patients with primary cutaneous melanoma and long follow- up. Ann Surg Oncol 2004;11:426–33. DOI: 10.1245/ASO.2004.07.014. PMID: 15070604

7. Kesmodel S.B., Karakousis G.C., Botbyl J.D. et al. Mitotic rate as a predictor of sentinel lymph node positivity in patients with thin melanomas. Ann Surg Oncol 2005;12(6):449–58. DOI: 10.1245/ASO.2005.04.027. PMID: 15864482

8. Balch C.M., Gershenwald J.E., Soong S.J. et al. Final version of 2009 AJCC melanoma staging and classification. J Clin Oncol 2009;27(36):6199–206. DOI: 10.1200/JCO.2009.23.4799. PMID: 19917835. PMCID: PMC2793035