Original Article
A single institution retrospective analysis of malignant melanoma Aytul Ozgen
ABSTRACT Background: The incidence of melanoma is rising at a rate greater than any other malignancy, although much of this increase is due to the more frequent diagnosis of patients with the earlier stages of melanoma. Objective: In this study, patient and tumor‑related characteristics and their effects on survival were evaluated. Materials and Methods: The data was drawn from the patients’ records with histologically proven primary cutaneous melanomas treated at the Ankara Oncology Hospital between January 2003 and December 2010. Sixty‑nine patients (48 men and 21 women) were included in this study. 17 of the patients had already distant metastases at the time of diagnosis. While 45 of all patients had undergone surgery alone, 17 had received only palliative radiotherapy, and 7 had received primary radiotherapy. Survival curves were determined from the time of diagnosis. Results: A total of 69 cutaneous melanoma cases were evaluated. While there was a predominance of males in all body sites, especially in the head and neck regions, the number of male patients was 5 times higher than females. Diseases located on the head tended to present a significantly higher rate in older patients (P = 0.009). Overall survival rates for 1 and 3 years were 79% and 44%, respectively. Distant metastatic melanoma was significantly related with poor prognosis (P 50 years. The American Joint Committee on Cancer (AJCC) staging system (7th edition) was applied for either clinical or pathological staging. [7] For externally referred patients without pathological evaluation of the Breslow thickness, clinical stages were defined based on the available T‑category, regional lymph node involvement, as well as status of distant metastasis. Stage was grouped into two categories; (1) regional melanoma: stage I, stage II, regional metastatic melanoma (stage III) defined as any stage without distant metastatic disease and (2) distant metastatic melanoma (stage IV) as any stage with distant metastases. While twenty‑four patients were treated with radiotherapy; forty‑five patients were treated with only surgery. Of the 24 patients who received radiotherapy, 7 had received primary radiotherapy and 17 had received radiotherapy with palliative intent. Table 1 lists patient and treatment characteristics. Seven patients received radiotherapy with 6‑12 MV megavoltage linear accelerator, and seventeen patients received radiotherapy with 60Co photon beam. Primary tumor and, if present, lymph node metastases were involved
Table 1: Patient and treatment characteristics Characteristics Gender (male/female) Age (years)(median/range) Anatomical area (H+N, Trunk, Limbs, nos/overlapping) T+N0 M0 AnyT N+M0 AnyT AnyN M+ Primary RT Palliative RT Surgery
n 48/21 53/26‑93 18/12/16/23 52 17 17 7 17 45
RT=Radiotherapy, NOS=Not other wise specified
in the treatment field. Median radiotherapy dose for patients treated with primary radiotherapy was 46 Gy and for palliative radiotherapy was 30 Gy. Survival curves were determined from the time of diagnosis of primary melanoma, and deemed censored for patients alive at last follow‑up or deceased without evidence of melanoma. Univariate analyses of end points for survival were achieved by using the Kaplan‑Meier method and the log‑rank test. SPSS 13 was used for statistical analysis. For the survival analyses, the following variables were included: Sex (male, female), age (≤50, >50 years), location of the melanoma (extremities, trunk, head and neck), clinically identified regional lymph node metastases (+,‑), clinically identified distant metastases (+,‑), and distant metastases (brain, lung, bone, and multiple). The Pearson Chi‑squared test was performed to investigate associations between the different patient and tumor characteristics. A value of P 50 compared to the males, but significant differences weren›t observed [Figure 1] (P = 0.98). The results were as follows: Rate of females: ≤50 = 42.9%, >50 = 57.1%. Rate of males: ≤50 = 44.2%, >50 = 55.8%. A higher rate of the males were in the age group > 50 compared to the age group of ≤ 50. In this study population, in all disease sites, there was a male predominancy. Between female patients the disease presented on the overlapping areas (43%) was more than other locations (limbs 24%, H + N 19%) [Figure 2]. At the time of diagnosis females were more likely to have distant metastatic melanoma than males (33% of females vs. 21% of males), but did not differ significantly [Figure 3] (P = 0.27). Also, the diseases located on the head and neck areas tended to present significantly in older patients (P = 0.009) [Figure 4]. After treatment, regional lymph node metastases outside the treatment field and distant metastases developed in 9 patients (13%) and 33 patients (48%), respectively. Figure 5 shows overall survival of all patients. Most of the regional lymph node metastases and distant metastases developed
within 2 years after the initial treatment. Overall survival rates for 1‑year and 3‑years were 79% and 44%, respectively. Overall survival rates for 1‑year and 3‑years of treatment with surgery alone were 88% and 74%, respectively. The results of univariate analysis for overall survival are shown in Table 2. Distant metastatic melanoma was significantly related to worse prognosis (P 50 yrs. (35) Gender Male (47), Female (21) Anatomic location H+N (17), trunk (12), limbs (16), nos (23) Stage Distant metastatic melanoma (17), regional melanoma (51) Metastases Brain (9), lung (3), multiple (5)
Overall survival P value 0.59 0.34 0.053
A single institution retrospective analysis of malignant melanoma Aytul Ozgen
ABSTRACT Background: The incidence of melanoma is rising at a rate greater than any other malignancy, although much of this increase is due to the more frequent diagnosis of patients with the earlier stages of melanoma. Objective: In this study, patient and tumor‑related characteristics and their effects on survival were evaluated. Materials and Methods: The data was drawn from the patients’ records with histologically proven primary cutaneous melanomas treated at the Ankara Oncology Hospital between January 2003 and December 2010. Sixty‑nine patients (48 men and 21 women) were included in this study. 17 of the patients had already distant metastases at the time of diagnosis. While 45 of all patients had undergone surgery alone, 17 had received only palliative radiotherapy, and 7 had received primary radiotherapy. Survival curves were determined from the time of diagnosis. Results: A total of 69 cutaneous melanoma cases were evaluated. While there was a predominance of males in all body sites, especially in the head and neck regions, the number of male patients was 5 times higher than females. Diseases located on the head tended to present a significantly higher rate in older patients (P = 0.009). Overall survival rates for 1 and 3 years were 79% and 44%, respectively. Distant metastatic melanoma was significantly related with poor prognosis (P 50 years. The American Joint Committee on Cancer (AJCC) staging system (7th edition) was applied for either clinical or pathological staging. [7] For externally referred patients without pathological evaluation of the Breslow thickness, clinical stages were defined based on the available T‑category, regional lymph node involvement, as well as status of distant metastasis. Stage was grouped into two categories; (1) regional melanoma: stage I, stage II, regional metastatic melanoma (stage III) defined as any stage without distant metastatic disease and (2) distant metastatic melanoma (stage IV) as any stage with distant metastases. While twenty‑four patients were treated with radiotherapy; forty‑five patients were treated with only surgery. Of the 24 patients who received radiotherapy, 7 had received primary radiotherapy and 17 had received radiotherapy with palliative intent. Table 1 lists patient and treatment characteristics. Seven patients received radiotherapy with 6‑12 MV megavoltage linear accelerator, and seventeen patients received radiotherapy with 60Co photon beam. Primary tumor and, if present, lymph node metastases were involved
Table 1: Patient and treatment characteristics Characteristics Gender (male/female) Age (years)(median/range) Anatomical area (H+N, Trunk, Limbs, nos/overlapping) T+N0 M0 AnyT N+M0 AnyT AnyN M+ Primary RT Palliative RT Surgery
n 48/21 53/26‑93 18/12/16/23 52 17 17 7 17 45
RT=Radiotherapy, NOS=Not other wise specified
in the treatment field. Median radiotherapy dose for patients treated with primary radiotherapy was 46 Gy and for palliative radiotherapy was 30 Gy. Survival curves were determined from the time of diagnosis of primary melanoma, and deemed censored for patients alive at last follow‑up or deceased without evidence of melanoma. Univariate analyses of end points for survival were achieved by using the Kaplan‑Meier method and the log‑rank test. SPSS 13 was used for statistical analysis. For the survival analyses, the following variables were included: Sex (male, female), age (≤50, >50 years), location of the melanoma (extremities, trunk, head and neck), clinically identified regional lymph node metastases (+,‑), clinically identified distant metastases (+,‑), and distant metastases (brain, lung, bone, and multiple). The Pearson Chi‑squared test was performed to investigate associations between the different patient and tumor characteristics. A value of P 50 compared to the males, but significant differences weren›t observed [Figure 1] (P = 0.98). The results were as follows: Rate of females: ≤50 = 42.9%, >50 = 57.1%. Rate of males: ≤50 = 44.2%, >50 = 55.8%. A higher rate of the males were in the age group > 50 compared to the age group of ≤ 50. In this study population, in all disease sites, there was a male predominancy. Between female patients the disease presented on the overlapping areas (43%) was more than other locations (limbs 24%, H + N 19%) [Figure 2]. At the time of diagnosis females were more likely to have distant metastatic melanoma than males (33% of females vs. 21% of males), but did not differ significantly [Figure 3] (P = 0.27). Also, the diseases located on the head and neck areas tended to present significantly in older patients (P = 0.009) [Figure 4]. After treatment, regional lymph node metastases outside the treatment field and distant metastases developed in 9 patients (13%) and 33 patients (48%), respectively. Figure 5 shows overall survival of all patients. Most of the regional lymph node metastases and distant metastases developed
within 2 years after the initial treatment. Overall survival rates for 1‑year and 3‑years were 79% and 44%, respectively. Overall survival rates for 1‑year and 3‑years of treatment with surgery alone were 88% and 74%, respectively. The results of univariate analysis for overall survival are shown in Table 2. Distant metastatic melanoma was significantly related to worse prognosis (P 50 yrs. (35) Gender Male (47), Female (21) Anatomic location H+N (17), trunk (12), limbs (16), nos (23) Stage Distant metastatic melanoma (17), regional melanoma (51) Metastases Brain (9), lung (3), multiple (5)
Overall survival P value 0.59 0.34 0.053
