Ulceration is defined pathologically as the absence of intact epithelium overlying
a melanoma. In patients with cutaneous melanoma, ulceration of the primary melanoma
is a well-known prognostic factor associated with decreased disease-free survival
(DFS) and overall survival (OS); presence or absence of ulceration has been incorporated
into the American Joint Committee on Cancer (AJCC) staging system for cutaneous melanoma
since the sixth edition in 2002 [
[1]
]. Although the factors underlying the prognostic significance of ulceration are still
largely unknown, ulceration is undoubtedly a marker of unfavorable tumor biology.
Recent data suggest that ulceration may be a predictive marker for response to adjuvant
interferon (IFN) alfa-2b therapy. This article reviews the data surrounding the prognostic
implications of ulceration in cutaneous melanoma.To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Advances in SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Greene F.L. Page D.L. Fleming I.D. AJCC cancer staging manual. 6th edition. Springer, New York2002
- Malignant melanoma. A clinicopathological analysis of the criteria for diagnosis and prognosis.Cancer. 1953; 6: 1-45
- Cutaneous melanoma: ulceration as a prognostic sign.Cancer. 1953; 6: 1215-1218
- Histology and prognosis in malignant melanoma.J Pathol. 1969; 97: 459-468
- Cutaneous melanoma: a twenty-year retrospective study with clinicopathologic correlation.Plast Reconstr Surg. 1975; 56: 277-285
- Prognostic factors in cutaneous malignant melanoma. A comparative study of long term and short term survivors.Hum Pathol. 1974; 5: 347-357
- The prognostic significance of ulceration of cutaneous melanoma.Cancer. 1980; 45: 3012-3017
- A multifactorial analysis of melanoma: prognostic histopathological features comparing Clark’s and Breslow’s staging methods.Ann Surg. 1978; 188: 732-742
- Prognostic significance of extent of ulceration in primary cutaneous melanoma.Am J Surg Pathol. 2006; 30: 1396-1400
- 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.J Clin Oncol. 2004; 22: 4376-4383
- Edge S.B. Byrd D.R. Compton C.C. AJCC cancer staging manual. 7th edition. Springer, New York2009
- Final version of 2009 AJCC melanoma staging and classification.J Clin Oncol. 2009; 27: 6199-6206
- Multi-institutional melanoma lymphatic mapping experience: the prognostic value of sentinel lymph node status in 612 stage I or II melanoma.J Clin Oncol. 1999; 17: 976-983
- Predicting sentinel and residual lymph node basin disease after sentinel lymph node biopsy for melanoma.Cancer. 2000; 89: 453-462
- Improved sentinel lymph node localization in patients with primary melanoma with the use of radiolabeled colloid.Surgery. 1998; 124: 203-210
- Significance of multiple nodal basin drainage in truncal melanoma patients undergoing sentinel lymph node biopsy.Ann Surg Oncol. 2000; 7: 256-261
- Factors that predict the presence of sentinel lymph node metastasis in patients with melanoma.Surgery. 2001; 130: 151-156
- Ulceration as a predictive marker for response to adjuvant interferon therapy in melanoma.Ann Surg. 2010; 252: 460-466
- Interferon alfa-2b adjuvant therapy of high-risk resected cutaneous melanoma: the Eastern Cooperative Oncology Group Trial EST 1684.J Clin Oncol. 1996; 14: 7-17
- High- and low-dose interferon alfa-2b in high-risk melanoma: first analysis of Intergroup Trial E1690/S9111/C9190.J Clin Oncol. 2000; 18: 2444-2458
- High-dose interferon alfa-2b significantly prolongs relapse-free and overall survival compared with the GM2-KLH/QS-21 vaccine in patients with resected stage IIB-III melanoma: results of Intergroup Trial E1694/S9512/C509801.J Clin Oncol. 2001; 19: 2370-2380
- A pooled analysis of Eastern Cooperative Oncology Group and Intergroup trials of adjuvant high-dose interferon for melanoma.Clin Cancer Res. 2004; 10: 1670-1677
- Final results of the Sunbelt Melanoma Trial.J Clin Oncol. 2008; 26 ([abstract: 9003]): 15s
- Ulceration of primary melanoma and responsiveness to adjuvant interferon therapy: analysis of the adjuvant trials EORTC18952 and EORTC18991 in 2,644 patients.J Clin Oncol. 2009; 27 ([abstract: 9007]): 15s
- The biology behind prognostic factors of cutaneous melanoma.Curr Opin Oncol. 2010; 22: 163-168
- Why do melanomas ulcerate?.J Cutan Pathol. 1984; 11: 269-273
- Tumor mitotic rate is a more powerful prognostic indicator than ulceration in patients with primary cutaneous melanoma: an analysis of 3661 patients from a single center.Cancer. 2003; 97: 1488-1498
- Tumor vascularity in the prognostic assessment of primary cutaneous melanoma.J Clin Oncol. 2002; 20: 1826-1831
- NF-kB in the vascular progression of melanoma.J Clin Oncol. 2004; 22: 617-623
- Matricellular proteins produced by melanocytes and melanomas: in search for functions.Cancer Microenviron. 2008; 1: 93-102
- Clinical correlates of NRAS and BRAF mutations in primary human melanoma.Clin Cancer Res. 2011; 17: 229-235
Article info
Publication history
Published online: July 04, 2011
Identification
Copyright
© 2011 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
