Originally published as JCO Early Release 10.1200/JCO.2004.12.015 on August 9 2004

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Thin Primary Cutaneous Malignant Melanoma: A Prognostic Tree for 10-Year Metastasis Is More Accurate Than American Joint Committee on Cancer Staging

From the Melanoma Program of the Abramson Cancer Center, Department of Biostatistics and Epidemiology, Department of Medicine, Department of Dermatology, Department of Pathology and Laboratory Medicine, and Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA

Address reprint requests to Phyllis A. Gimotty, PhD, Department of Biostatistics and Epidemiology, 631 Blockley Hall, 423 Guardian Dr, Philadelphia, PA 19104-6021; e-mail: pgimotty{at}cceb.upenn.edu

PURPOSE: The majority of invasive primary melanomas are thin ( 1.00 mm). Since the current staging system imperfectly predicts outcome in patients with such lesions, we sought to develop a more effective classification scheme to better identify both patients at high risk of metastasis who are candidates for further staging and therapy and those with little risk.

PATIENTS AND METHODS: This prospective cohort study included 884 patients who had thin invasive melanomas. A tree-structured analysis of 10-year metastasis was used to develop a new classification scheme.

RESULTS: The overall 10-year metastasis rate was 6.5% (95% CI, 4.8% to 8.1%). The prognostic tree defined four risk groups: high-risk: men with vertical growth phase (VGP) lesions that had mitotic rates (MRs) greater than 0, and for whom the 10-year metastasis rate was 31% (22% to 42%; n = 90); moderate-risk: women with VGP lesions that had MRs greater than 0 and for whom the rate was 13% (9% to 18%; n = 136); low-risk: patients with VGP lesions that had MR of 0 for whom the rate was 4% (2% to 7%; n = 247); and minimal-risk: patients with invasive lesions without VGP for whom the rate was 0.5% (0% to 1.2%; n = 411). Survival curves differed significantly among the four groups (P < .001).

CONCLUSION: Growth phase, mitotic rate, and sex are important prognostic factors for patients with thin melanomas, and they identify subgroups at substantial risk for metastasis. After validation in other populations, the proposed prognostic tree will be useful in the design of clinical trials and clinical management.

Supported in part by the following grants: Prediction and Modification of Melanoma Risk (CA-75434; D.G.) and SPORE on Skin Cancer (CA-093372; Meenhard Herlyn, principal investigator).

Presented in part at the 38th Annual Meeting of the American Society of Clinical Oncology, Orlando, FL, May 18-21, 2002.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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