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Impact of Ulceration in Stages I to III Cutaneous Melanoma As Staged by the American Joint Committee on Cancer Staging System: An Analysis of the German Central Malignant Melanoma Registry

From the Department of Dermatology, Skin Cancer Program, Central Malignant Melanoma Registry of the German Dermatological Society, Eberhard-Karls-University of Tuebingen, Tuebingen, Germany; and Skin Cancer Research Group, School of Public Health and Tropical Medicine, James Cook University, Townsville, Australia

Address reprint requests to Claus Garbe, MD, Department of Dermatology, Eberhard-Karls-University, Liebermeisterstrasse 25, D-72076 Tuebingen, Germany; e-mail: claus.garbe{at}med.uni-tuebingen.de

PURPOSE: In 2001, the new American Joint Committee on Cancer classification of cutaneous melanoma (CM) introduced ulceration of the primary melanoma as a new key parameter being represented in respective subcategories of the tumor (T) classification. The present study was performed to validate the prognostic significance of ulceration in relation to T thickness and clinical stages of CM (stages I to III).

PATIENTS AND METHODS: Patients (N = 15,158) with incident invasive primary nonmetastatic CM and follow-up data recorded between 1976 and 2000 by the German Central Malignant Melanoma Registry were investigated using survival analysis to evaluate prognostic factors such as T thickness, level of invasion, body site, histologic subtype, ulceration, regression, age, and sex.

RESULTS: Comparisons of survival probabilities according to the Kaplan-Meier method between ulcerated and nonulcerated CM were not statistically significant for subgroups with T thickness 1 mm and more than 4.00 mm (P = .2601 and P = .0699, respectively) but were significant for T thickness of 1.01 to 2.00 mm and 2.01 to 4.00 mm (P < .0001 for both). This result was confirmed in the multivariate analysis. For stage III CM, the impact of ulceration on overall survival was statistically significant in the bivariate Cox model (P = .0111) but not in the multivariate Cox model (P = .0522).

CONCLUSION: Whereas ulceration seems to have a negative impact on the prognosis of patients with stages T2 and T3, a potential influence for patients with stages T1 and T4 could not be established. If factors of the primary CM were to be taken into consideration to judge prognosis of stage III CM, T thickness but not ulceration should be the focus.

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

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