The prognostic impact of the extent of ulceration in patients with clinical stage I-II melanoma: a multicentre study of the Italian Melanoma Intergroup (IMI)

Background The presence of ulceration has been recognized as an adverse prognostic factor in primary cutaneous melanoma (PCM). Objectives To investigate whether the extent of ulceration (EoU) predicts relapse-free survival (RFS) and overall survival (OS) in PCM. Materials and methods We retrieved data for 477 patients with ulcerated PCM from databases of the Italian Melanoma Intergroup. Univariate and multivariable Cox proportional hazard models were used to assess the independent prognostic impact of EoU. Results A significant interaction emerged between Breslow thickness (BT) and EoU, considering both RFS (P < 0 center dot 0001) and OS (P = 0 center dot 0006). At multivariable analysis, a significant negative impact of EoU on RFS [hazard ratio (HR) (1-mm increase) 1 center dot 26, 95% confidence interval (CI) 1 center dot 08-1 center dot 48, P = 0 center dot 0047] and OS [HR (1-mm increase) 1 center dot 25, 95% CI 1 center dot 05-1 center dot 48, P = 0 center dot 0120] was found in patients with BT <= 2 mm, after adjusting for BT, age, tumour-infiltrating lymphocytes, sentinel lymph node status and mitotic rate. No impact of EoU was found in patients with 2 center dot 01-4 mm and > 4 mm BT. Conclusions This study demonstrates that EoU has an independent prognostic impact in PCM and should be recorded as a required element in pathology reports.

Automated summary

The study showed that the extent of ulceration has an independent prognostic impact in primary cutaneous melanoma and should be included as a required element in pathology reports.