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Histological Characteristics of Metastasizing Thin Melanomas
A Case-Control Study of 43 Cases
Joan Guitart, MD;
Lori Lowe, MD;
Michael Piepkorn, MD, PhD;
Victor G. Prieto, MD, PhD;
Michael S. Rabkin, MD, PhD;
Salve G. Ronan, MD;
Christopher R. Shea, MD;
Victor A. Tron, MD;
Wain White, MD;
Raymond L. Barnhill, MD
Arch Dermatol. 2002;138:603-608.
Objective To study clinical and histological features associated with metastasizing
thin melanomas (MTMs).
Design Case-control study of clinicopathological features of patients with
MTMs by a panel of 10 dermatopathologists.
Setting Members of the North American Melanoma Pathology Study Group selected
the cases from the melanoma databases at 8 academic institutions.
Patients Forty-three patients with MTMs (<1 mm thick) and 42 control subjects
without metastasis matched for age, sex, tumor site, and Breslow thickness.
Intervention None.
Main Outcome Measures Clinical (age, sex, site of lesion, stage at diagnosis, metastasis site,
disease-free survival, and outcome) and histological (Breslow thickness, Clark
level, growth phase, regression, and inflammatory response) features of patients
with MTMs vs controls.
Results There was an overrepresentation of axial tumors among patients with
MTMs. Extensive regression was present in 18 patients (42%) with MTM vs 2
matched control subjects (5%) (95% confidence interval, 21%-53%; P = .001). Other histological variables were not significantly different.
Two patients had melanomas in situ with subsequent metastasis.
Conclusions Thin melanomas with extensive regression represent a group at higher
risk for the development of metastasis. Furthermore, the risk of metastasis
cannot be dismissed in cases of melanoma in situ.
From the Department of Dermatology, Northwestern University Medical
School, Chicago, Ill (Dr Guitart); Department of Pathology, University of
Michigan, Ann Arbor (Dr Lowe); Department of Dermatology, University of Washington,
Seattle (Dr Piepkorn); Department of Pathology, M. D. Anderson Cancer Center,
Houston, Tex (Dr Prieto); Rabkin Dermatopathology Laboratory, Pittsburgh,
Pa (Dr Rabkin); Department of Pathology, University of Illinois, Chicago (Dr
Ronan); Department of Dermatology, Duke University, Durham, NC (Dr Shea);
Department of Pathology, University of Alberta, Edmonton (Dr Tron); Department
of Pathology, Bowman-Gray School of Medicine, Winston-Salem, NC (Dr White);
and Department of Dermatology, Georgetown University Medical Center, Washington,
DC (Dr Barnhill). Dr Shea is now affiliated with the Department of Medicine,
The University of Chicago.
Dr Ronan is deceased.
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