Prognosis for localized cutaneous melanoma treated with wide excision only, with special reference to development of regional node metastases

A consecutive series of 564 patients with localized (Stage I) melanoma treated by wide excision only were followed for at least 5 years. The median tumor thickness was 1.50 mm, and 30% were ulcerated. The female/male ratio was 54/46. The overall survival rates were 80% at 5 years and 73% at 10 years. The survival rates were statistically significantly better for females, even when tumor thickness and ulceration were taken into consideration. Twenty percent developed regional node metastases after an average remission period of 13 months. The actuarial survival rates after node dissection were 32% at 5 years and 27% at 10 years. A subgroup with an exceptionally poor prognosis and a high rate of regional node dissemination was looked for. Only 26% of the intermediate thickness group (1.50-3.99 mm, Breslow) developed nodal metastasis, whereas patients with thick lesions (greater than 4 mm) had a metastasis rate of 43%. Patients with thick lesions may therefore benefit more from elective node dissection than patients with lesions of intermediate thickness. Patient characteristics, e.g., sex and tumor characteristics (ulceration), may prove to be of importance in a prospective trial on elective node dissection.