Primary malignant melanoma of the limbs: a re-evaluation using microstaging techniques.

The pathologic material from 256 patients with malignant melanoma of the limb seen between 1955 and 1969 was reviewed to correlate the clinical course of the disease with the microstage, in an attempt to determine whether treatment factors affect the course of the disease. Rates of disease recurrence observed during the ten-year follow-up period were: Level II--19%, III--33%; IV--54% and V--94%, while for measured depths the recurrence rates were less than 0.5 mm--18%; 0.5 to 1 mm--26%; 1 to 1.5 mm--44%; 1.5 to 2 mm--49%; 2 to 3 mm--78% and greater than 3 mm--74%. For those patients with Level II melanomas, or Level III less than 1 mm, there was no difference in disease recurrence or survival, whether they were treated by wide local excision, with or without lymph node dissection, or by regional chemotherapy. For the more deeply invasive melanomas, rates of disease recurrence, survival and time to recurrence were all statistically better for those treated by regional therapy, confirming a treatment effect for malignant melanoma patients.