Clinical presentation, natural history and prognostic factors in advanced malignant melanoma.

A retrospective study of the clinical findings and natural history of 140 patients with disseminated malignant melanoma treated at Wayne State University over a ten year period was done. Multiple organ metastases were diagnosed clinically in 78 per cent of all patients and seen at all autopsies. Routine roentgenograms of the chest did not diagnose metastases to the lung in 27 per cent of the patients. The concimitant elevation of alkaline phosphatase, serum glutamic-oxalacetic transaminase and serum glutamic-pyruvic transaminase enzymes is suggestive of underlying metastases to the liver even with a negative liver scan or normal liver size. Electroencephalography was found to be sensitive in predicting and confirming metastases to the central nervous system prior to clinical manifestation with a 97 per cent accuracy rate in clinically confirmed instances as compared with a 60 per cent accuracy rate with brain scan. Age, sex and primary site of melanoma did not influence the survival once the disease became disseminated. Patients with a disease-free interval of more than six months statistically have a better chance of survival from the onset of systemic metastases, p = 0.001. Patients with a poor performance status of less than or equal to 40 per cent had a median survival period of one month as compared with six months with 90 per cent performance, p = 0.001. Patients who initially presented with metastases to the skin or lymph nodes without other visceral involvement had a 14 month median survival rate as compared with eight months in patients with metastases to the central nervous system only, four months with metastases to the liver and only one month in patients with multiple organ involvement, p = 0.0001.