Results of treatment of 269 patients with primary cutaneous melanoma: a five-year prospective study.

A prospective protocol for the management of primary cutaneous melanoma was initiated at the University of Illinois in October 1968 and continued through June 1974. Over this period 269 cases were treated: 42 of the head and neck region, 75 of the trunk, 94 of the lower extremities and 58 of the upper exremities. The levels of invasion ranged from II to V, according to Clark's classification; level I melanomas were excluded. The status of the regional nodes was correlated with the level of invasion. Preliminary exploratory celiotomies were performed on all patients with lower extremity melanomas and on all those with level IV or V melanoma with clinically positive regional nodes. All patients were treated with wide excision and elective regional node dissection except those in whom celiotomy showed disseminated disease. Of the 150 patients now eligible for five-year analysis, 33 had level II disease, three with positive nodes. None had local recurrence or intra-abdominal metastasis. All 33 (100%) were cancer-free at five years. Of 56 with level III, 23 had positive regional nodes, two had local recurrence within two years, and two with melanoma of the lower extremities had intra-abdominal metastases. At five years 53 (95%) of the 56 were cancer-free. Of the 42 with level IV, 31 had positive regional nodes, five had local recurrence and five had intra-abdominal metastases; 21 (50%) survived for five years. Of the 19 with level V, 17 had positive nodes, three had local recurrence and five intra-abdominal metastases; 7 (37%) were five-year survivors. Of the 150, 114 (76%) were cancer-free at five years. On the basis of these findings, it was concluded that wide local excision is adequate for level II and probably for thin level III. But for thick level III and levels IV and V the best salvage rate is obtained by an aggressive surgical approach.