Histological ulceration as a prognostic factor in cutaneous melanoma: a study of 423 cases in Spain

Abstract

Introduction: Histological ulceration in cutaneous melanoma carries a high risk of metastasis and has a poor prognosis. However, some epidemiological and survival studies of patients with cutaneous melanoma do not consider histological ulceration as one of the main prognostic factors.

Materials and methods: Epidemiological, clinical, histological and survival characteristics of all patients diagnosed with cutaneous melanoma over a 10-year period (1994- 2003) were retrospectively analysed.

Results: Ulcerated melanoma was observed in 77 of 423 patients (18.2%). Ulceration was significantly associated with male sex, deeper tumour thickness, positive sentinel lymph node biopsy and metastasis (p<0.001). Histological ulceration indicates a high relative risk (RR) of death from melanoma (RR 9.41; 95% CI 4.52-19.59) and a significant risk of metastasis (RR 5.72; 95% CI 3.56-9.19) (p<0.001).

Conclusions: Histological ulceration is associated with lower overall survival and disease-free survival in patients with cutaneous melanoma. Presence of ulceration must be included in the clinical history of patients with melanoma to ensure a careful diagnostic work-up and follow-up.