Deeply invasive cutaneous malignant melanoma

Two hundred and forty-eight patients presented with cutaneous malignant melanoma during a period of five years; 78, ~31 per cent, had Clark's level 4 and 5 lesions. Seventy patients completed a ten year follow-up period of examination and were studied for survival. Fifty-one patients, ~73 per cent, presented with clinical Stage I disease, and the remaining 19, ~27 per cent, were classified as having clinical Stage II disease. The 51 patients were treated initially with wide excision of the lesion along with skin, subcutaneous tissue and fascia. Of these, 26 never required regional lymphadenectomy and had a median survival time of 61 months, while the other 25 did require regional lymph node dissection at a later date, when metastases to the lymph nodes were confirmed, and they had a median survival time of 31 months. However, the survival figures for these two groups were statistically not significant, p>0.10. On the other hand, 19 patient who presented with clinical Stage II disease were treated with wide excision of the primary and regional lymphadenectomy. Twelve of these were classified as having pathological Stage II disease and had a median survival time of 19 months. The other seven patients had no tumor in the lymph nodes, pathological Stage I disease, and had a survival time of 33 months. The statistical analyses of these data clearly indicated that the stage of the disease rather than the role of regional lymphadenectomy had a significant prognostic value. Therefore, wide excision of the primary site and close follow-up examination should be the approach for Stage I cutaneous malignant melanoma, including those with Clark's level 4 and 5 level of invasion. The exception to this rule should be for clinical reasons, such as patients with a primary lesion overlying a lymph node area or those admitted to adjuvant studies for accurate pathologic staging at the time of diagnosis.