Department of Medical Oncology, Institute of Oncology, Istanbul University, Istanbul, Turkey; and.
Department of Medical Oncology, Koc University, Istanbul, Turkey.
Am J Dermatopathol. 2022 Nov 1;44(11):799-805. doi: 10.1097/DAD.0000000000002264. Epub 2022 Jul 19.
The histological subtype is not considered one of the major prognostic factors in melanoma, yet it is known to have an impact on survival. The aim of this study was to investigate the clinical significance of histological subtypes and the possible impacts of clinicopathological factors on the course of melanoma patients of all stages. A total of 1017 cutaneous melanoma patients were analyzed retrospectively. Four major melanoma histotypes that were studied in this study were as follows: (1) superficial spreading melanoma (SSM), (2) nodular melanoma (NM), (3) acral lentiginous melanoma (ALM), and (4) lentigo maligna melanoma (LMM). Unlike SSMs and LMMs, there were statistically significant correlations between NMs and ALMs and most aggressive histopathological prognostic indicators, such as higher Clark level ( P = 0.0001), thick Breslow depth ( P = 0.0001), presence of ulceration ( P = 0.0001), and lymphovascular invasion ( P = 0.0001). Furthermore, NMs and ALMs were also associated with advanced clinical stages, that is, node involvement and metastasis. Relapse rates for nonmetastatic melanomas were higher in NMs (39.6%) and ALMs (35.3%) than in SSMs (24.3%) and LMMs (10.3%) ( P = 0.0001). Additionally, 5-year relapse-free survival rates were 90.5%, 70.5%, 55.7%, and 50.5% in LMMs, SSMs, ALMs, and NMs, respectively ( P = 0.0001). Moreover, 5-year overall survival rates plummeted from 84.3% in LMMs to 74.8%, 64.3%, and 46% in SSMs, ALMs, and NMs, respectively ( P = 0.0001). In conclusion, we observed that the histologic subtype was an independent predictor for relapse and outcome for cutaneous melanoma patients. Both NM and ALM had unfavorable prognoses, and they were associated with known poor pathological and clinical indicators.
组织学亚型不被认为是黑色素瘤的主要预后因素之一，但已知它会影响生存。本研究旨在探讨组织学亚型的临床意义以及临床病理因素对所有阶段黑色素瘤患者病程的可能影响。对 1017 例皮肤黑色素瘤患者进行回顾性分析。本研究研究的四种主要黑色素瘤组织学类型如下：（1） 浅表扩散性黑色素瘤（SSM），（2） 结节性黑色素瘤（NM），（3） 肢端雀斑样黑色素瘤（ALM）和（4） 恶性雀斑样黑色素瘤（LMM）。与 SSM 和 LMM 不同，NM 和 ALM 与大多数侵袭性组织病理学预后指标之间存在统计学显著相关性，例如更高的Clark 级别（P=0.0001）、较厚的 Breslow 深度（P=0.0001）、溃疡存在（P=0.0001）和淋巴血管侵犯（P=0.0001）。此外，NM 和 ALM 还与晚期临床分期有关，即淋巴结受累和转移。非转移性黑色素瘤的复发率在 NM（39.6%）和 ALM（35.3%）中高于 SSM（24.3%）和 LMM（10.3%）（P=0.0001）。此外，LMM、SSM、ALM 和 NM 的 5 年无复发生存率分别为 90.5%、70.5%、55.7%和 50.5%（P=0.0001）。此外，5 年总生存率从 LMM 的 84.3%降至 SSM、ALM 和 NM 的 74.8%、64.3%和 46%（P=0.0001）。总之，我们观察到组织学亚型是皮肤黑色素瘤患者复发和结局的独立预测因子。NM 和 ALM 预后不良，与已知的不良病理和临床指标有关。
