PRIMARY melanomas with incipient ulceration may warrant a higher-risk pathologic T stage, as they could be more aggressive than nonulcerated melanomas, suggests a new case-control study. “Assessment of the prognostic implication of incipient ulceration is of potential clinical significance, given that the prognosis of these patients is currently uncertain,” explained Elizabeth Paver, Melanoma Institute Australia at the University of Sydney, Australia.
The study evaluated the clinicopathological factors and outcomes of patients with incipiently ulcerated melanoma, compared with ulcerated or nonulcerated melanoma. A total of 340 patients (median age: 69 years; 68% male) who were diagnosed with resected primary cutaneous melanoma between 2005–2015 were included. The team matched 40 incipiently ulcerated melanoma cases with 80 nonulcerated controls and 80 ulcerated controls.
Data showed a higher median Breslow thickness for tumours with incipient ulceration (2.8 mm) compared to nonulcerated melanomas (1 mm); however, these were thinner than ulcerated melanomas (5.3 mm). The team also noted a greater median mitotic activity in incipiently ulcerated tumours (5 per mm2) compared with nonulcerated tumours (1 per mm2), but lower than ulcerated tumours (9 per mm2). Results further showed that incipiently ulcerated tumours were more likely to have lymphovascular invasion, satellite lesions, and positive sentinel nodes, compared with nonulcerated tumours.
Overall survival and recurrent-free survival were significantly higher in those with nonulcerated tumours, compared with incipient ulceration (hazard ratio [HR]: 0.49; 95% confidence interval [CI]: 0.27–0.88 versus HR: 0.37; 95% CI: 0.22–0.64, respectively); however, those with ulcerated tumours had significantly worse recurrence-free survival, compared to those with incipiently ulcerated tumours (HR: 1.67; 95% CI: 1.07–2.6).
The authors concluded: “The findings of this retrospective case-control study indicate that the classification of primary melanomas with incipient ulceration as nonulcerated and assigning them a lower-risk pathologic T stage may not be appropriate.” They advised that in the future, pathologists should comment on the presence of incipient ulceration in pathology reports of primary melanomas.
