Histopathological and Survival Analysis of 157 Malignant Melanoma Cases Over a 10-Year Period

Abstract

Objective: Malignant melanoma (MM) is an aggressive cancer responsible for 80% of deaths caused by skin cancers. Despite the increase in the incidence of MM in our country, existing studies are limited in number and mostly focus on cutaneous melanomas. The aim of this study is to evaluate the epidemiological and clinicopathological characteristics and survival data of MM patients diagnosed at our clinic and to contribute to the literature.
Methods: A total of 157 malignant melanoma cases were retrospectively examined in terms of gender, age, tumor location, histological subtype, lymph node involvement, Clark and Breslow stages, mitotic count, presence of satellite lesions, ulceration, regression, tumour lymphocytic response, metastasis sites, treatment methods applied, and survival.
Results: The majority of cases were found to be at an advanced stage and had high tumour thickness. Most histological and clinical parameters showed predominantly high-risk features. Metastasis distribution and overall survival analyses supported the poor prognosis associated with late presentation.
Conclusions: In Türkiye, data suggest the incidence of MM is increasing but available studies are limited in number. In this study, we indicate that MM cases in our region are frequently diagnosed at an advanced stage This situation reveals that the society needs to be more aware of malignant melanoma, risk factors and prevention methods. We aimed to describe the epidemiologic, clinicopathologic, and survival characteristics of patients diagnosed with MM and to contribute these data to the literature.

Keywords

• Melanoma
• Cutaneus
• Skin neoplasm
• Survival
• Metastasis

Ethical Statement

In 2015, ethical committee approval was obtained by the Karadeniz Technical University Clinical Research Ethics Committee with the registration number 24237859-227.

References

1. Saginala K, Barsouk A, Aluru JS, Rawla P, Barsouk A. Epidemiology of melanoma. Med Sci (Basel). 2021;9(4):63. doi:10.3390/medsci9040063.
2. Parlak A, Çayırlı M, Parlak M, Ekinci Ş. Melanoma genel bakış. Konuralp Tıp Dergisi. 2014;6(1):22-7. doi:10.18521/ktd.39906
3. Rastrelli M, Tropea S, Rossi CR, Alaibac M. Melanoma: epidemiology, risk factors, pathogenesis, diagnosis and classification. In Vivo. 2014;28(6):1005-11.
4. De Pinto G, Mignozzi S, La Vecchia C, Levi F, Negri E, Santucci C. Global trends in cutaneous malignant melanoma incidence and mortality. Melanoma Res. 2024;34(3):265-75. doi:10.1097/CMR.0000000000000959.
5. Raimondi S, Suppa M, Gandini S. Melanoma epidemiology and sun exposure. Acta Derm Venereol. 2020;100(11):adv00136. doi:10.2340/00015555-3491.
6. Ünal TD. Kütanöz ve mukozal malign melanom olgularının histopatolojik analizi [Histopathological analysis of cutaneous and mucosal malignant melanoma cases]. Bozok Tıp Derg. 2018;8(1):31 7.
7. Tas F, Kurul S, Camlica H, Topuz E. Malignant melanoma in Turkey: a single institution's experience on 475 cases. Jpn J Clin Oncol. 2006;36(12):794-9. doi:10.1093/jjco/hyl114.
8. Şimşek T, Sönmez A, Demir A, Tayfur V, Güneren E, Eroğlu L, et al. Kutanöz malign melanomlu 84 hastaya ait klinik deneyimlerimiz. Turkplastsurg. 2011;19(3):113 6.

9. Karasoy A, Karşıdağ S, Tatlıdede S, Uğurlu K, Özkaya Ö, Kuran İ, et al. Malign melanomda 13 yılda 65 hastadaki deneyimimiz: retrospektif çalışma. Turkplastsurg. 2004;12(3):153-7.
10. Zheng S, Yu H, Zheng X, Wu UT, Ming WK, Huang H, et al. Analysis and prediction of 5-year survival in patients with cutaneous melanoma: a model-based period analysis. Front Endocrinol (Lausanne). 2023;14:1238086. doi:10.3389/fendo.2023.1238086.
11. Borges SZ, Bakos L, Cartell A, Wagner M, Agostini A, Lersch E. Distribution of clinical-pathological types of cutaneous melanomas and mortality rate in the region of Passo Fundo, RS, Brazil. Int J Dermatol. 2007;46(7):679-86. doi:10.1111/j.1365-4632.2007.03037.x.
12. Gamsizkan M, Yilmaz I, Buyukbabani N, Demirkesen C, Demiriz M, Cetin ED, et al. A retrospective multicenter evaluation of cutaneous melanomas in Turkey. Asian Pac J Cancer Prev. 2014;15(23):10451-6. doi:10.7314/apjcp.2014.15.23.10451.
13. Külahcı Y, Zor F, Öztürk S, Eski M, Deveci M, Şengezer M. Yetmiş dokuz malign melanoma olgusunun retrospektif analizi. Turk Plast Surg. 2008;16(1):15-9.
14. Büyükpınarbaşılı N, Demirkesen C, Oğuz O, Kaner G. Kutanöz malign melanomlarda prognostik faktörler. Turkderm. 2002;36(2):115-23.
15. Meteoroloji Genel Müdürlüğü. Türkiye Ortalama Güneşlenme Süresi (1991-2020) [Internet]. Ankara: Meteoroloji Genel Müdürlüğü; ©1998-2023 [cited 2020 Oct 27]. Available from: https://www.mgm.gov.tr/kurumici/turkiye-guneslenme-suresi.aspx
16. Bilkay U, Erdem Ö, Özek C, Karabulut B, Tokat C, Gürler T, et al. Nodüler melanomda dokuz yıllık uygulama ve sonuçlarımız. Turk Plast Surg. 2000;8(3):149-52.
17. Devrim T, Karahan N. Süleyman Demirel Üniversitesi Tıp Fakültesi Tıbbi Patoloji Anabilim Dalında tanı alan kutanöz malign melanom olgularının retrospektif değerlendirilmesi. SDÜ Tıp Fak Derg. 2015;22(1):8-13.
18. Lattanzi M, Lee Y, Simpson D, Moran U, Darvishian F, Kim RH, et al. Primary melanoma histologic subtype: impact on survival and response to therapy. J Natl Cancer Inst. 2019;111(2):180-8. doi:10.1093/jnci/djy086.
19. Bartlett EK, Karakousis GC. Current staging and prognostic factors in melanoma. Surg Oncol Clin N Am. 2015;24(2):215-27. doi:10.1016/j.soc.2014.12.001.
20. Jethanamest D, Vila PM, Sikora AG, Morris LG. Predictors of survival in mucosal melanoma of the head and neck. Ann Surg Oncol. 2011;18(10):2748-56. doi:10.1245/s10434-011-1685-4.
21. Morton DL, Thompson JF, Cochran AJ, Mozzillo N, Elashoff R, Essner R, et al. Sentinel-node biopsy or nodal observation in melanoma. N Engl J Med. 2006;355(13):1307-17. doi:10.1056/NEJMoa060992.
22. Keung EZ, Gershenwald JE. The eighth edition American Joint Committee on Cancer (AJCC) melanoma staging system: implications for melanoma treatment and care. Expert Rev Anticancer Ther. 2018;18(8):775-84. doi:10.1080/14737140.2018.1489246.
23. Ramnath EM, Kamath D, Brobeil A, Stall A, Kamath VV, Cruse CW, et al. Lymphatic mapping for melanoma: long-term results of regional nodal sampling with radioguided surgery. Cancer Control. 1997;4(6):483-90. doi:10.1177/107327489700400601.
24. Levi F, Randimbison L, La Vecchia C, Te VC, Franceschi S. Prognostic factors for cutaneous malignant melanoma in Vaud, Switzerland. Int J Cancer. 1998;78(3):315-9. doi:10.1002/(SICI)1097-0215(19981029)78:3<315::AID-IJC10>3.0.CO;2-5.
25. Marashi-Pour S, Morrell S, Cooke-Yarborough C, Arcorace M, Baker D. Competing risk analysis of mortality from invasive cutaneous melanoma in New South Wales: a population-based study, 1988–2007. Aust N Z J Public Health. 2012;36(5):441-5. doi:10.1111/j.1753-6405.2012.00912.x.
26. Lallas A, Apalla Z, Moscarella E, Zalaudek I, Tzellos T, Lefaki I, et al. Extensive regression in pigmented skin lesions: a dangerous confounding feature. Dermatol Pract Concept. 2012;2(2):202a08. doi:10.5826/dpc.0202a08.
27. Harrist TJ, Rigel DS, Day CL Jr, Sober AJ, Lew RA, Rhodes AR, et al. “Microscopic satellites” are more highly associated with regional lymph node metastases than is primary melanoma thickness. Cancer. 1984;53(10):2183-7. doi:10.1002/1097-0142(19840515)53:10<2183::aid-cncr2820531029>3.0.co;2-9.
28. Leboit PE, Burg G, Weedon D, Sarasin A. World Health Organization of tumours: skin tumours. Lyon, France: IARC Press; 2006. p. 49-120.
29. Balch CM, Buzaid AC, Soong SJ, Atkins MB, Cascinelli N, Coit DG, et al. Final version of the American Joint Committee on Cancer staging system for cutaneous melanoma. J Clin Oncol. 2001;19(16):3635-48. doi:10.1200/JCO.2001.19.16.3635.
30. Balch CM. Cutaneous melanoma: prognosis and treatment results worldwide. Semin Surg Oncol. 1992;8(6):400-14. doi:10.1002/ssu.2980080611.
31. Frishberg DP, Balch C, Balzer BL, Crowson AN, Didolkar M, McNiff JM, et al. Protocol for the examination of specimens from patients with melanoma of the skin. Arch Pathol Lab Med. 2009;133(10):1560-7. doi:10.5858/133.10.1560.
32. Rollins BJ. Inflammatory chemokines in cancer growth and progression. Eur J Cancer. 2006;42(6):760-7. doi:10.1016/j.ejca.2006.01.002.
33. Clark WH Jr, Elder DE, Van Horn M. The biologic forms of malignant melanoma. Hum Pathol. 1986;17(5):443-50. doi:10.1016/S0046-8177(86)80032-6.
34. Elder DE, Guerry D 4th, Van Horn M, Hurwitz S, Zehngebot L, Goldman L I, et al. The role of lymph node dissection for clinical stage I malignant melanoma of intermediate thickness (1.51–3.99 mm). Cancer. 1985;56(2):413-8. doi:10.1002/1097-0142(19850715)56:2<413::aid-cncr2820560234>3.0.co;2-t.
35. Oble DA, Loewe R, Yu P, Mihm MC Jr. Focus on TILs: prognostic significance of tumor infiltrating lymphocytes in human melanoma. Cancer Immun. 2009;9:3.
36. Clemente CG, Mihm MC Jr, Bufalino R, Zurrida S, Collini P, Cascinelli N. Prognostic value of tumor infiltrating lymphocytes in the vertical growth phase of primary cutaneous melanoma. Cancer. 1996;77(7):1303-10. doi:10.1002/(SICI)1097-0142(19960401)77:7<1303::AID-CNCR12>3.0.CO;2-5.
37. Balch CM, Soong SJ, Gershenwald JE, Thompson JF, Reintgen DS, Cascinelli N, et al. Prognostic factors analysis of 17,600 melanoma patients: validation of the American Joint Committee on Cancer melanoma staging system. J Clin Oncol. 2001;19(16):3622-34. doi:10.1200/JCO.2001.19.16.3622.
38. Aydın HÖ, Ünal OÜ, Somalı I, Öztop İ, Yılmaz AU. Malign melanomlu hastaların klinikopatolojik incelenmesi. Acta Oncol Turc. 2015;48(2):67-72. doi:10.5505/aot.2015.63634.
39. Özçelik S, Akyol M. Melanoma epidemiyolojisi. Turkderm. 2007;41(2):22-7.
40. Barnhill RL. Pathology of melanocytic nevi and malignant melanoma. 2nd ed. New York: Springer; 2004. doi:10.1007/978-0-387-21619-5.