Melanoma natural history, complications and prognosis: Difference between revisions

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:*'''Stage IV''': Distant Metastasis, 9-15% Survival
:*'''Stage IV''': Distant Metastasis, 9-15% Survival


Please check the [[Melanoma staging|staging]] page for more details about the staging scheme and the TNM classification.
''Please check the [[Melanoma staging|staging]] page for more details about the staging scheme and the TNM classification.''


*The Breslow's depth is independent of other features of the tumor, and has been demonstrated to predict 5-year survival:
*The Breslow's depth is independent of other features of the tumor, and has been demonstrated to predict 5-year survival:
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*Certain types of melanoma have worse prognoses but this is explained by their [[Breslow's depth|thickness]]. Interestingly, less invasive melanomas even with lymph node metastases carry a better prognosis than deep melanomas without regional metastasis at time of staging. 
*Local recurrences tend to behave similarly to a primary unless they are at the site of a [[wide local excision]] (as opposed to a staged excision or punch/shave excision) since these recurrences tend to indicate lymphatic invasion.
*When melanomas have spread to the [[lymph node]]s, one of the most important factors is the number of nodes with malignancy. 
*Extent of malignancy within a node is also important; micro-metastases in which malignancy is only microscopic have a more favorable prognosis than macrometastases.   
*Extent of malignancy within a node is also important; micro-metastases in which malignancy is only microscopic have a more favorable prognosis than macrometastases.   
*In some cases micrometastases may only be detected by special staining, and if malignancy is only detectable by a rarely-employed test known as [[polymerase chain reaction]] (PCR), the prognosis is better.  
*In some cases micrometastases may only be detected by special staining, and if malignancy is only detectable by a rarely-employed test known as [[polymerase chain reaction]] (PCR), the prognosis is better.  
*Macrometastases in which malignancy is clinically apparent (in some cases cancer completely replaces a node) have a far worse prognosis, and if nodes are matted or if there is extracapsular extension, the prognosis is still worse.
*Macrometastases in which malignancy is clinically apparent (in some cases cancer completely replaces a node) have a far worse prognosis, and if nodes are matted or if there is extracapsular extension, the prognosis is still worse.
 
*Metastases to skin and lungs have a better prognosis than metastases to the brain, bone and liver, which are associated with a worse prognosis.
When there is distant metastasis, the cancer is generally considered incurable. The five year survival rate is less than 10%.<ref name=AJCC>{{cite journal | author = Balch C, Buzaid A, Soong S, Atkins M, Cascinelli N, Coit D, Fleming I, Gershenwald J, Houghton A, Kirkwood J, McMasters K, Mihm M, Morton D, Reintgen D, Ross M, Sober A, Thompson J, Thompson J | title = Final version of the American Joint Committee on Cancer staging system for cutaneous melanoma. | journal = J Clin Oncol | volume = 19 | issue = 16 | pages = 3635-48 | year = 2001 | id = PMID 11504745}}''[http://www.jco.org/cgi/content/full/19/16/3635 Full text]''</ref> The median survival is 6 to 12 months. Treatment is [[Palliative care|palliative]], focusing on life-extension and quality of life.  In some cases, patients may live many months or even years with metastatic melanoma (depending on the aggressiveness of the treatment).  Metastases to skin and lungs have a better prognosis. Metastases to brain, bone and liver are associated with a worse prognosis.
 
There is not enough definitive evidence to adequately stage, and thus give a prognosis for ocular melanoma and melanoma of soft parts, or mucosal melanoma (e.g. rectal melanoma), although these tend to metastasize more easily.  Even though regression may increase survival, when a melanoma has regressed, it is impossible to know its original size and thus the original tumor is often worse than a [[Pathology|pathology report]] might indicate.


===5-Year Survival===
===5-Year Survival===
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* When stratified by age, the 5-year relative survival of patients with melanoma was 92.7% and 88.2% for patients <65 and ≥ 65 years of age respectively.<ref name="SEER">Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z,Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2011, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2011/, based on November 2013 SEER data submission, posted to the SEER web site, April 2014.</ref>
* When stratified by age, the 5-year relative survival of patients with melanoma was 92.7% and 88.2% for patients <65 and ≥ 65 years of age respectively.<ref name="SEER">Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z,Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2011, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2011/, based on November 2013 SEER data submission, posted to the SEER web site, April 2014.</ref>
*When there is distant metastasis, the cancer is generally considered incurable. The five year survival rate is less than 10%.<ref name=AJCC>{{cite journal | author = Balch C, Buzaid A, Soong S, Atkins M, Cascinelli N, Coit D, Fleming I, Gershenwald J, Houghton A, Kirkwood J, McMasters K, Mihm M, Morton D, Reintgen D, Ross M, Sober A, Thompson J, Thompson J | title = Final version of the American Joint Committee on Cancer staging system for cutaneous melanoma. | journal = J Clin Oncol | volume = 19 | issue = 16 | pages = 3635-48 | year = 2001 | id = PMID 11504745}}''[http://www.jco.org/cgi/content/full/19/16/3635 Full text]''</ref>


* The survival of patients with melanoma varies with the stage of the disease.  Shown below is a table depicting the 5-year relative survival by the stage of melanoma:<ref name="SEER">Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z,Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2011, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2011/, based on November 2013 SEER data submission, posted to the SEER web site, April 2014.</ref>
* The survival of patients with melanoma varies with the stage of the disease.  Shown below is a table depicting the 5-year relative survival by the stage of melanoma:<ref name="SEER">Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z,Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2011, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2011/, based on November 2013 SEER data submission, posted to the SEER web site, April 2014.</ref>

Revision as of 21:38, 21 August 2015

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Features that affect prognosis are tumor thickness in millimeters (Breslow's depth), depth related to skin structures (Clark level), type of melanoma, presence of ulceration, presence of lymphatic/perineural invasion, presence of tumor infiltrating lymphocytes (if present, prognosis is better), location of lesion, presence of satellite lesions, and presence of regional or distant metastasis.[1] Between 2004 and 2010, the 5-year relative survival of patients with melanoma was 92.9%.[2]

Complications

  • Bone metastases
  • Cerebral metastases
  • Cutaneous metastasis
  • Lung metastases
  • Renal metastases

Prognosis

  • Features that affect prognosis include tumor thickness in millimeters (Breslow's depth), depth related to skin structures (Clark level), type of melanoma, presence of ulceration, presence of lymphatic/perineural invasion, presence of tumor infiltrating lymphocytes (if present, prognosis is better), location of lesion, presence of satellite lesions, and presence of regional or distant metastasis.[3]
  • The TNM staging classification summarizes most of these findings. Using the TNM classification, prognosis can be determined based on the stage of the disease as follows:
  • Stage 0: Melanoma in Situ, 100% Survival
  • Stage I: Invasive Melanoma, 85-95% Survival
  • Stage II: High Risk Melanoma, 40-85% Survival
  • Stage III: Regional Metastasis, 25-60% Survival
  • Stage IV: Distant Metastasis, 9-15% Survival

Please check the staging page for more details about the staging scheme and the TNM classification.

  • The Breslow's depth is independent of other features of the tumor, and has been demonstrated to predict 5-year survival:
Breslow's Depth 5-year survival
< 0.76 mm 95% to 100%
0.76-1.5 mm 80% to 96%
1.5-4 mm 60% to 75%
> 4 mm 37% to 50%
  • Extent of malignancy within a node is also important; micro-metastases in which malignancy is only microscopic have a more favorable prognosis than macrometastases.
  • In some cases micrometastases may only be detected by special staining, and if malignancy is only detectable by a rarely-employed test known as polymerase chain reaction (PCR), the prognosis is better.
  • Macrometastases in which malignancy is clinically apparent (in some cases cancer completely replaces a node) have a far worse prognosis, and if nodes are matted or if there is extracapsular extension, the prognosis is still worse.
  • Metastases to skin and lungs have a better prognosis than metastases to the brain, bone and liver, which are associated with a worse prognosis.

5-Year Survival

  • Between 2004 and 2010, the 5-year relative survival of patients with melanoma was 92.9%.[2]
  • When stratified by age, the 5-year relative survival of patients with melanoma was 92.7% and 88.2% for patients <65 and ≥ 65 years of age respectively.[2]
  • When there is distant metastasis, the cancer is generally considered incurable. The five year survival rate is less than 10%.[4]
  • The survival of patients with melanoma varies with the stage of the disease. Shown below is a table depicting the 5-year relative survival by the stage of melanoma:[2]
Stage 5-year relative survival (%), (2004-2010)
All stages 91.3%
Localized 98.1%
Regional 62.6%
Distant 16.1%
Unstaged 78.4%
  • Shown below is an image depicting the 5-year conditional relative survival (probability of surviving in the next 5-years given the cohort has already survived 0, 1, 3 years) between 1998 and 2010 of melanoma by stage at diagnosis according to SEER. These graphs are adapted from SEER: The Surveillance, Epidemiology, and End Results Program of the National Cancer Institute.[2]

5-year conditional relative survival (probability of surviving in the next 5-years given the cohort has already survived 0, 1, 3 years) between 1998 and 2010 of melanoma by stage at diagnosis according to SEER

References

  1. ↑ Homsi J, Kashani-Sabet M, Messina J, Daud A (2005). "Cutaneous melanoma: prognostic factors". Cancer Control. 12 (4): 223–9. PMID 16258493.Full text (PDF)
  2. ↑ 2.0 2.1 2.2 2.3 2.4 Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z,Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2011, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2011/, based on November 2013 SEER data submission, posted to the SEER web site, April 2014.
  3. ↑ Homsi J, Kashani-Sabet M, Messina J, Daud A (2005). "Cutaneous melanoma: prognostic factors". Cancer Control. 12 (4): 223–9. PMID 16258493.Full text (PDF)
  4. ↑ Balch C, Buzaid A, Soong S, Atkins M, Cascinelli N, Coit D, Fleming I, Gershenwald J, Houghton A, Kirkwood J, McMasters K, Mihm M, Morton D, Reintgen D, Ross M, Sober A, Thompson J, Thompson J (2001). "Final version of the American Joint Committee on Cancer staging system for cutaneous melanoma". J Clin Oncol. 19 (16): 3635–48. PMID 11504745.Full text

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