Malignant melanoma of the upper extremities.

There were 487 patients treated for malignant melanoma of the upper extremities at the Pack Medical Group in New York City between 1939 and 1967 inclusive, fourth in frequency (14.7%) of total malignant melanomas treated here, being exceeded by malignant melanoma of the trunk (34%), head and neck (23%), and the lower extremities (20%). A 10-year survival rate of 342 determinate patients was 63%. Fourteen percent of the patients who died of melanoma died between the fifth and tenth years, indicating the need to report survival at the 10-year span. Survival was equal for the sexes (61% male and 64% female). The majority of the patients had infiltrating melanomas (Clark's Level 4 and 5) with a survival rate of 62%. Ten patients with superficial spreading melanomas (Clark's Level 2 and 3) and juvenile melanomas enjoyed a 100% 10-year survival. The worst prognosis was for six patients with amelanotic melanoma in that only two of ten survived ten years or longer. The question of elective axillary dissection remains elusive. In 106 patients classified as clinical Stage I, elective axillary dissection was performed in 55 instances, and 26 patients had microscopic evidence of metastases. Their 10-year survival rate was 65%, slightly higher than 16 patients in whom no elective axillary dissection was performed, among whom six later developed evidence of metastases, underwent therapeutic node dissections, and had a 10-year survival of 56%. Radical amputation is occasionally indicated with great palliation and often prolongation of life.