Multivariate analysis of prognostic factors in patients with nodular melanoma

Purpose Nodular melanoma (NM) is associated with worse disease outcome when compared to superficial spreading melanoma (SSM). We aimed to perform a single-center analysis of prognostic factors in patients with NM and compare the data with SSM patients. Methods We studied 228 patients with NN and 396 patients with SSM. Patients with in situ melanomas or stage IV at diagnosis were not included in the study. Data were analyzed using the Mann-Whitney test, Chi-square test, Kaplan-Meier curves including the log-rank test, and logistic regression model. Results When compared to patients with SSM, patients with NM had less likely lower Clark level, higher tumor thickness, less likely tumor regression, more often ulcerated tumors, and less likely a history of precursor lesions such as a nevus. Within a 5-year follow-up we observed significantly more disease relapses and deaths in NM patients than in SSM patients. On multivariate analysis, disease relapse in NM patients was independently predicted by tumor thickness and positive SLNB, whereas melanoma-specific death of NM patients was independently predicted by male sex and tumor thickness. Histologic regression also remained in the logistic regression model as a significant independent negative predictor of NM death. Conclusions We did not observe that NM subtype was per se a significant independent predictor for disease relapse or melanoma-specific death. Among the well-known prognostic factors such as tumor thickness and male sex, NM is also associated with other unfavorable factors such as absence of regression.

Automated summary

When compared to SSM patients, NM patients are more likely to have higher Clark levels, thicker tumors, less tumor regression, more frequently ulcerated tumors, and less likely precursor lesions such as nevi. NM patients have significantly higher rates of disease relapse and death within a 5-year follow-up. On multivariate analysis, tumor thickness and positive SLNB predict disease relapse in NM patients, while male sex and tumor thickness predict melanoma-specific death in NM patients. Histologic regression also remains a significant independent negative predictor of NM death.