Prognostic analysis of malignant melanoma according to the surgical protocols

Abstract

Background

The importance of melanoma has recently been brought to light due to increasing incidence and the difficulty to treat in advanced stage of this disease. However, there is a paucity of reported data regarding melanoma behavior in Korea.

Methods

In a total of 423 melanoma patients, with 267 of them receiving a surgical treatment from 2005 to 2014 at Severance Hospital, the clinicopathologic characteristics of malignant melanoma and prognostic outcomes according to different surgical procedures were analyzed, retrospectively.

Results

When we compared the overall survival in four main types of cutaneous melanoma, nodular melanoma showed the worst prognosis, followed by acral lentiginous melanoma (ALM). Histologic subtype significantly influenced overall survival (p<0.001). Two hundred thirty patients with cutaneous melanoma were treated with conventional wide local excision, and 37 patients underwent slow Mohs procedures due to skin preservation, incompletely excised or recurred melanoma, difficult anatomical site, and unclear surgical margin. The follow-up analysis showed that slow Mohs surgery can be another efficacious for treating cutaneous melanomas, which have radial growth phase features and high-risk characteristics, with maximum conservation of surrounding tissue. In analysis of 62 patients with ALM of 1.01 to 2.0 mm thickness, wide excision with 1 versus 2 cm margins revealed no significant difference in the outcome analysis; no significant difference was observed in the frequency of total recurrence and death attributed to melanoma between the two groups (p = 0.721 and 0.623, respectively).

Conclusion

The results of the present study will be an important contributor towards our understanding and treating the disease.