Primary tumour ulceration in cutaneous melanoma: its role on TNM stages

Abstract

Background: Tumour ulceration has unfavourable prognostic factor in stage I-II melanoma. The aim of this study was to question whether tumour ulceration might predict relapse and survival in melanomas of all stages. Methods: A total of 911 melanoma patients were analysed. Results: The 5-year relapse-free survival rates were 50.0% for ulcerated melanomas and 75.8% for all non-ulcerated melanomas (P = 0.0001). Ulcerated melanomas had lower relapse-free survival rates than non-ulcerated melanomas in all T-stages (P = 0.0001). The relapse-free survival rates were statistically significant for T1 (P = 0.02), T3 (P = 0.01) and T4 (P = 0.004); however, T2 (P = 0.07). There were significant differences between ulcerated melanomas and non-ulcerated melanomas regarding relapse-free survival rates for both N0 (P = 0.0001) and N1 (P = 0.01) patients; poor relapse-free survival rates were found to be in association with ulcerated melanomas (P = 0.06 for N1, P = 0.04 for N2 and P = 0.8 for N3 disease). The 5- year overall survival rates were 55.3 and 81.5% for ulcerated melanomas and non-ulcerated melanomas, respectively (P = 0.0001). Ulcerated melanomas had lower overall survival rates than non-ulcerated melanomas in all Tstages; they were statistically significant for T1 (P = 0.01), T2 (P = 0.03) and T4 ( P = 0.006), but not for T3 (P = 0.3). Ulceration predicted poor survival in N0 patients; however, it was not found significant although its overall survival rate was lower in node-positive patients (P = 0.09), and ulceration was a significantly poor prognostic factor only for N3 patients (P = 0.03), but not for N1 (P = 0.9) and N2 patients (P = 0.2). Furthermore, non-metastatic patients with ulcerated melanomas survived significantly less (P = 0.0001), but there were no differences in survivals between ulcerated melanoma and non-ulcerated melanoma metastatic melanoma patients (P = 0.1). Conclusion: Primary tumour ulceration has been considered as a poor prognostic factor in local melanomas, but it might also have a potential for predicting survival in loco-regional and advanced melanomas.