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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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