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Numerous studies have assessed the prognostic value of the size of ulceration in clinically localized cutaneous melanoma. In fact, the presence of ulceration was already established as an adverse prognostic factor back in the s. Now, the team led by John Thompson and Richard Scolyer has not only confirmed the importance of the extent of ulceration in predicting melanoma prognosis, but has also described how the size of the ulceration is actually a better prognosis factor than the mere presence or absence of ulceration.
The study included patients with ulcerated melanoma and 4, patients with non-ulcerated melanoma. Because the gene profiles of ulcerated and non-ulcerated melanomas are very different, further studies would confirm if these genetic profiles could explain the different behaviour of the disease.
In 't Hout, F. Prognostic importance of the extent of ulceration in patients with clinically localized cutaneous melanoma. Article Google Scholar. Download references. Localized but larger tumors may have other traits such as ulceration that put them at high risk of spreading. Learn more about sentinel lymph node biopsy and melanoma treatment options. Spread beyond the primary tumor to other parts of the body.
There are also subdivisions within these stages. These stages are each further broken down, from lowest to highest risk, depending on different characteristics of the original tumor and the areas where it has spread. Cancer staging can be complex and confusing.
If you have been diagnosed, ask your doctor to explain your stage in a way you can understand. Learn more about melanoma treatment options.
Reviewed by: Allan C. Halpern, MD Ashfaq A. Diagnosis and Staging. What it Means for You. How is melanoma diagnosed? What happens next? What are the melanoma stages, and what do they mean? What happens after staging? Warning Signs.
Risk Factors. I've been diagnosed with melanoma. What Is Breslow depth? The phenomenon has been defined as thinning of epidermis, attenuation of basal and suprabasal layers, and loss of the normal rete ridge configuration in areas overlying melanoma tissue.
These figures are in line with those reported in previous studies. In this latter study, COE was frequently found at the edges of ulcerated areas, and it was thought of as an early step in the progression toward ulceration. In this study, we defined COE as general thinning, involving more than two-thirds of the epidermis. We did not define thinning of the epidermis only in wound edges or under a scab as COE but rather as a possible instance of reepithelialization.
By this classification, COE is more likely a precursor and not a result of ulceration. The presence of a thin epidermis under or at the edges of a scab was seen in this study as a possible instance of reepithelialization, and enlargement of epidermis or elongated rete ridges was considered reactive epidermal hyperplasia. These are described phases during wound healing, subsequent to ulceration and wounding. Scratching as a traumatic ulceration may be impossible to distinguish from tumor-induced ulceration, though, since these lesions would present a vital reaction of the underlying melanoma tissue, with an unknown biological and prognostic impact.
Interestingly, by combining the extent of ulceration and the presence of epidermal involvement, we demonstrated equivalent 5-year survival rates for patients with a normal epidermis and patients with minimal to moderate ulceration without epidermal involvement, while patients with minimal to moderate ulceration with epidermal involvement and patients with excessive ulcerations showed significantly poorer survival and were independent prognostic factors in multivariate analysis Figure 1D and Table 3.
The prognostic significance of ulceration is well established, and its presence upstages patients with localized melanoma by both subcategories and stages. The presence of epidermal involvement of the surrounding epidermis was coded separately. Currently, there is no evidence-based definition of ulceration and no consensus in the published literature.
Further studies including different institutions and trained pathologists would be relevant and represent a limitation to the present study. In conclusion, despite the limitations of this retrospective study and design, we suggest that ulceration is a heterogeneous phenomenon with independent prognostic impact of both the extent and type of ulceration.
Furthermore, the combination of ulceration extent as a percentage of the ulceration length over the total tumor length and epidermal involvement presence of COE, reepithelialization, or reactive epidermal hyperplasia provided additional prognostic information and may be useful markers, allowing better stratification of ulcerated lesions.
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Malignant melanoma prognostic factors 4: ulceration width. J Dermatol Surg Oncol. Interobserver reproducibility of histopathologic prognostic variables in primary cutaneous melanomas. Tumor mitotic rate is a more powerful prognostic indicator than ulceration in patients with primary cutaneous melanoma: an analysis of patients from a single center.
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Stat Med. Consumption of the epidermis: a criterion in the differential diagnosis of melanoma and dysplastic nevi that is associated with increasing Breslow depth and ulceration. Am J Dermatopathol. Seckin S Ozgun E. The importance of consumption of the epidermis in malignant melanoma and correlation with clinicopathological prognostic parameters. Turk Patoloji Derg. Consumption of the epidermis in acral lentiginous melanoma.
J Cutan Pathol. Martin P. Wound healing—aiming for perfect skin regeneration. Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide. Sign In or Create an Account. Sign In. Advanced Search. Search Menu. Article Navigation. Close mobile search navigation Article Navigation.
Volume Article Contents Abstract. Materials and Methods. Oxford Academic. Christensen, MSc. Tine E.
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