Znamiona – Rokowania, prognozy i postęp choroby

Znamiona
Rokowania, prognozy i postęp choroby

Rokowanie u pacjentów ze znamionami predysponującymi do czerniaka jest ściśle związane z wczesnym rozpoznaniem i leczeniem. Kluczowe czynniki prognostyczne obejmują grubość guza pierwotnego (np. 10-letnie przeżycie spada z 96% przy zmianach <4 mm), obecność owrzodzenia, wskaźnik mitotyczny (20 mitoz/mm² wiąże się z 10-letnim przeżyciem około 48% vs 93% przy ≤1 mitozie/mm²), oraz przerzuty do węzłów chłonnych (mikroskopowe przerzuty dają 63% 10-letniego przeżycia, makroskopowe 47%). Dodatkowo, lokalizacja zmiany (lepsze rokowanie na kończynach niż na tułowiu, głowie czy szyi), płeć (kobiety mają korzystniejsze wyniki), wiek, typ histologiczny (czerniak guzkowy ma gorsze rokowanie), poziom LDH oraz obecność przerzutów odległych znacząco wpływają na prognozę. System AJCC jest standardowym narzędziem do oceny stopnia zaawansowania i przewidywania wyników leczenia.

Znamiona – Prognoza (przewidywanie wyniku)

Kluczowe czynniki prognostyczne
Dodatkowe czynniki wpływające na rokowanie
Wskaźniki przeżycia według stadium
Regresja czerniaka a rokowanie
Nowe modele predykcyjne w przewidywaniu rokowania
Indywidualizacja prognozy
Prognoza – kluczowe wnioski
Kolejne rozdziały

Znamiona – Prognoza (przewidywanie wyniku)

Rokowanie dla pacjentów ze znamionami, które mogą przekształcić się w czerniaka, zależy od wielu czynników. Prognoza i przeżywalność są ściśle powiązane z wczesnym rozpoznaniem i odpowiednim leczeniem. U pacjentów z wcześnie wykrytym czerniakiem rokowanie jest bardzo dobre, z odsetkiem przeżyć bliskim 100%¹. Jednakże prognoza znacząco się pogarsza, jeśli diagnoza zostanie postawiona w późniejszych stadiach progresji¹.

Kluczowe czynniki prognostyczne

Amerykański Wspólny Komitet ds. Raka (AJCC) opracował system oceny stopnia zaawansowania, który jest globalnie uznawany za nieocenione narzędzie w przewidywaniu wyników u pacjentów z rozpoznanym czerniakiem. System ten opiera się na danych pochodzących z analizy dziesiątek tysięcy przypadków czerniaka skóry¹. Najważniejsze cechy histopatologiczne, które wpływają na rokowanie, obejmują:

Grubość guza pierwotnego – odnosi się do liczby warstw skóry, w które wrósł. Jest to ważny czynnik prognostyczny, ponieważ pomaga przewidzieć ryzyko rozprzestrzenienia się nowotworu. Grubsze guzy mają wyższe ryzyko przerzutów do innych części ciała i nawrotu po leczeniu¹. Zwiększająca się grubość czerniaka skóry koreluje z pogarszającymi się wynikami przeżycia, spadając z 96% 10-letniego przeżycia dla zmian 4 mm².
Owrzodzenie – pierwotny guz z owrzodzeniem ma mniej korzystne rokowanie niż guz bez owrzodzenia. Owrzodzenie zwiększa ryzyko rozprzestrzenienia się nowotworu do innych części ciała i nawrotu po leczeniu¹. Na każdej grubości guza wykazano, że obecność owrzodzenia nabłonka w guzie pierwotnym skutkuje gorszym rokowaniem niż w przypadku braku owrzodzenia¹.
Wskaźnik mitotyczny – zwiększony wskaźnik mitotyczny jest związany z gorszym rokowaniem¹. Wskaźnik 20 mitoz/mm² skutkuje 10-letnim przeżyciem wynoszącym około 48% w porównaniu do 93% u osób z ≤1 mitozą/mm²².
Przerzuty do węzłów chłonnych – jeśli nowotwór rozprzestrzenił się do pobliskich węzłów chłonnych, rokowanie jest gorsze. Im więcej węzłów chłonnych zawiera nowotwór, tym gorsze jest rokowanie². Obecność mikroskopowych przerzutów do węzłów chłonnych skutkuje 10-letnim wskaźnikiem przeżycia wynoszącym 63%, ale jeśli obecna jest choroba makroskopowa, spada on do 47%¹.

Dodatkowe czynniki wpływające na rokowanie

Oprócz głównych czynników histopatologicznych, kilka innych czynników ma znaczący wpływ na rokowanie:

Lokalizacja pierwotna – znamiona występujące na ramionach lub nogach (kończynach) mają lepsze rokowanie niż znamiona na centralnej części ciała (tułów), głowie lub szyi². Zmiany pojawiające się centralnie (tułów, głowa i szyja) zwykle mają gorsze rokowanie niż te pojawiające się na kończynach (dolnych i górnych)².
Płeć – kobiety zwykle mają lepsze rokowanie niż mężczyźni po zdiagnozowaniu czerniaka². W przypadku wczesnego stadium (III) czerniaka, płeć żeńska ma również pozytywne implikacje prognostyczne, być może związane z większą liczbą cienkich, nieowrzodziałych zmian na kończynach rozpoznawanych u kobiet¹.
Wiek – ogólnie osoby starsze mają gorsze rokowanie². Dobrze ustalono, że wiek jest niezależnym czynnikiem prognostycznym, przy czym gorsze wyniki związane są z rosnącym wiekiem².
Typ histologiczny – czerniak guzkowy ma złe rokowanie, ponieważ rośnie w głąb warstw skóry (pionowy wzorzec wzrostu) i zazwyczaj jest gruby w momencie diagnozy².
Markery biochemiczne – wysoki poziom dehydrogenazy mleczanowej (LDH) we krwi ma gorsze rokowanie niż w przypadku normalnego poziomu LDH². W analizie wieloczynnikowej podwyższony poziom LDH przewiduje około 50% niższe wskaźniki przeżycia u pacjentów z przerzutami odległymi².
Przerzuty odległe – czerniak ma złe rokowanie, gdy rozprzestrzenia się do innych części ciała (tzw. przerzuty odległe), takich jak płuca, wątroba lub mózg². Przerzuty do innych miejsc mają niekorzystne implikacje prognostyczne. Satelitarne zmiany skórne zmniejszają przeżycie w podobnym stopniu co przerzuty do węzłów chłonnych, z pogarszającym się rokowaniem w przypadku przerzutów do płuc i dalszym pogorszeniem w przypadku zajęcia jakiegokolwiek innego narządu².
Markery genetyczne – zwiększone wykorzystanie profilowania ekspresji genów dostarcza również dalszych genetycznych wskazówek prognostycznych. Mutacja genu BRAF, która jest integralną częścią patogenezy czerniaka, została również zbadana jako marker prognostyczny. Wydaje się być powiązana ze znanymi czynnikami prognostycznymi, takimi jak wiek i miejsce pierwotne, jednocześnie nie będąc powiązaną z czynnikami takimi jak miejsce przerzutu i LDH¹. W zaawansowanej chorobie meta-analizy wykazały, że obecność mutacji BRAF jest niezależnie związana z gorszym wynikiem przeżycia².

Wskaźniki przeżycia według stadium

Wskaźniki przeżycia dla czerniaka są ogólnymi szacunkami i muszą być interpretowane z dużą ostrożnością. Ponieważ te statystyki są oparte na doświadczeniach grup ludzi, nie mogą być wykorzystywane do przewidywania szans przeżycia konkretnej osoby¹. Niemniej jednak:

Stadium I – prawie wszyscy (około 100%) pacjenci z czerniakiem skóry w stadium 1 przeżyją 5 lat lub więcej po diagnozie¹. 5-letni wskaźnik przeżycia wynosi około 97% dla Stadium IA, a 10-letni wskaźnik przeżycia około 95%¹.
Stadium II – około 85 na 100 osób (około 85%) z czerniakiem skóry w stadium 2 przeżyje 5 lat lub więcej po diagnozie¹.
Stadium III – prawie 75 na 100 osób (prawie 75%) z czerniakiem skóry w stadium 3 przeżyje 5 lat lub więcej po diagnozie¹.
Stadium IV – 5-letni wskaźnik przeżycia wynosi około 15% do 20% dla Stadium IV. 10-letni wskaźnik przeżycia wynosi 10% do 15%. Ten wskaźnik jest wyższy, jeśli nowotwór rozprzestrzenił się tylko na skórę lub odległe węzły chłonne, a nie do narządów życiowych². Nowsze dane dotyczące przeżycia w Stadium IV sugerują poprawę wskaźnika przeżycia: wczesne dane z badań klinicznych terapii celowanej i kombinowanej immunoterapii wykazały pięcioletnie wskaźniki przeżycia wahające się od 34-52% dla tej wybranej grupy pacjentów¹.

Regresja czerniaka a rokowanie

Chociaż obecnie nie jest wymagana do określenia stadium, regresja jest parametrem histopatologicznym zazwyczaj raportowanym przy diagnozie inwazyjnego pierwotnego czerniaka skóry¹. Badania analizujące znaczenie prognostyczne regresji dla wyników pacjentów dały kontrowersyjne wyniki; prawdopodobnie dlatego, że definicja i ocena regresji nie były spójne, oprócz subiektywności interpretacji patologów¹.

Regresja może być ważnym wskaźnikiem prognostycznym, ponieważ udokumentowano kilka przypadków czerniaka początkowo prezentującego się jako przerzuty regionalne (np. skórne lub do węzłów chłonnych) w kontekście całkowitej regresji pierwotnego czerniaka lub nieznanego guza pierwotnego, sugerując związek między regresją a przerzutami².

Znaczenie prognostyczne regresji w pierwotnym czerniaku jest kontrowersyjne od wielu lat¹:

Kilka badań nie wykazało korelacji między regresją a wynikiem pacjenta¹.
W przeciwieństwie do tego, inne badania wskazują, że obecność regresji w czerniaku była związana ze złym rokowaniem².
Z drugiej strony, dodatkowe badania sugerowały, że regresja wskazuje na korzystny wynik².
W niedawnym badaniu 1349 czerniaków skóry, Morris i wsp. wykazali, że regresja korelowała ze zmniejszonym nawrotem miejscowym i systemowym³.

Nowe modele predykcyjne w przewidywaniu rokowania

W ostatnich latach opracowano szereg nowych narzędzi do prognozowania wyników pacjentów z czerniakiem, wykorzystujących zaawansowane techniki, takie jak sztuczna inteligencja i uczenie maszynowe:

Algorytmy AI w diagnozie – wczesne wykrycie czerniaka, potencjalnie śmiertelnego typu raka skóry o wysokiej częstości występowania na całym świecie, poprawia rokowanie pacjenta¹. Badania wykazały, że algorytmy AI mogą wykazywać znaczącą przewagę wydajności w heterogenicznych zestawach danych zawierających wyłącznie zmiany podejrzane o czerniaka, oferując potencjalne wsparcie dla dermatologów, szczególnie w diagnostyce trudnych przypadków¹.
Modele oparte na parach genów związanych z układem odpornościowym (IRGPs) – badania wykazały, że sygnatura składająca się z 33 IRGPs była znacząco związana z przeżyciem pacjentów w zestawie danych TCGA-SKCM (P = 2.01016, współczynnik ryzyka (HR) = 4.220 (2.909 do 6.122))¹. Sygnatura IRGPs pozostała niezależną wartością predykcyjną OS zarówno w jednowymiarowej, jak i wielowymiarowej analizie Coxa w zestawie danych walidacyjnym (P≤0,01)².
Wynik VTS dla przerzutów do mózgu – badacze zaproponowali prognostyczny wynik VTS dla pacjentów z czerniakiem poddawanych lokalnej terapii przerzutów do mózgu, który uwzględnia systemową terapię IT/TT. Wynik VTS był znacząco związany z OS z medianą OS w trzech grupach wynoszącą odpowiednio 5,1, 18,9 i 34,5 miesiąca¹.

Indywidualizacja prognozy

Ważne jest, aby pamiętać, że wskaźniki przeżycia nie przewidują przeżycia jednostki. Każda osoba i każdy przypadek są różne, a wiele czynników przyczynia się do przeżycia jednostki¹. Warto również pamiętać, że w ciągu ostatnich kilku lat pojawiły się nowe i skuteczne metody leczenia, a wskaźniki przeżycia wzrosły w przypadku czerniaka w stadium III i IV¹.

Prognoza zależy od wielu czynników, w tym¹:

Historii zdrowia pacjenta
Typu nowotworu
Miejsca rozpoczęcia nowotworu na skórze
Stadium, w tym grubości guza i obecności owrzodzenia
Wybranych metod leczenia
Odpowiedzi nowotworu na leczenie

Tylko lekarz zaznajomiony z tymi czynnikami może połączyć wszystkie te informacje ze statystykami przeżycia, aby ustalić rokowanie². Lekarz, który najlepiej zna stan zdrowia pacjenta, jest w najlepszej pozycji, aby omówić rokowanie i wyjaśnić, co statystyki mogą oznaczać w konkretnym przypadku¹.

Prognoza – kluczowe wnioski

W Kanadzie 5-letnie przeżycie netto dla czerniaka skóry wynosi 89%. Oznacza to, że średnio około 89% osób zdiagnozowanych z czerniakiem będzie żyć przez co najmniej 5 lat². Przeżycie różni się w zależności od stadium czerniaka. Ogólnie rzecz biorąc, im wcześniej czerniak zostanie zdiagnozowany i leczony, tym lepszy wynik. Większość czerniaków jest wykrywana we wczesnym stadium, a ten typ nowotworu często dobrze reaguje na leczenie².

Gdy czerniak zostanie wcześnie wykryty i odpowiednio leczony, jest wysoce uleczalny¹. Jednak prognoza zależy od stadium choroby w momencie rozpoznania. W stadium IV choroby, gdy występują przerzuty odległe, nowotwór jest generalnie uważany za nieuleczalny, a mediana przeżycia wynosi mniej niż rok, chociaż niektórzy pacjenci żyją przez kilka lat¹.

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Materiały źródłowe

#1 Azthena logo with the word Azthena
https://www.news-medical.net/health/Melanoma-Prognosis.aspx
The prognosis for a patient with melanoma depends on a number of different characteristics of the tumor, including the type and stage of progression. […] If melanoma can be diagnosed early, the prognosis is very high with a survival rate close to 100%, but the prognosis is significantly worsened if the diagnosis is not made until the later stages of progression. […] Certain types of melanoma are associated with a better or poorer prognosis, which is usually related to the typical thickness of the type. Melanomas that are less invasive tend to have a better prognosis than deep melanomas, even if there is the involvement of the lymph nodes. […] The size of the metastases changes the prognosis, with micrometastases associated with a better prognosis than patients with macrometastases. The location of the metastases also has an effect, with a better prognosis for lesions in the skin or lungs and a poorer prognosis when the brain, bone and liver are involved.
#1 Melanoma epidemiology, biology and prognosis
https://pmc.ncbi.nlm.nih.gov/articles/PMC4041476/
Prognostic factors in cutaneous melanoma have been closely studied; they include histopathological characteristics, patient characteristics, biochemical measures and most recently genetic mutations. Each of these will be considered in turn. […] The American Joint Committee on Cancer (AJCC) staging system is globally acknowledged as an invaluable tool in predicting outcomes for patients diagnosed with melanoma. It is based on data derived from analysis of tens of thousands of cutaneous melanoma patients; the current seventh edition was introduced early in 2010 and incorporated new factors not previously used in the estimation of melanoma prognosis. […] Histopathological features logically form the main criteria for determining prognosis. Increasing thickness of the cutaneous primary correlates with worsening survival outcomes, dropping from 96% 10-year survival for lesions 1 mm, to 54% for lesions 4 mm; even for lesions 1 mm in thickness, there is further deterioration in outcome between lesions 0.25 mm thickness and those 0.75 mm.
#1 Prognosis and survival for melanoma skin cancer | Canadian Cancer Society
https://cancer.ca/en/cancer-information/cancer-types/melanoma-skin/prognosis-and-survival
A prognosis is the doctor’s best estimate of how cancer will affect you and how it will respond to treatment. Survival is the percentage of people with a disease who are alive at some point in time after their diagnosis. Prognosis and survival depend on many factors. […] Prognostic and predictive factors are often discussed together. They both play a part in deciding on a prognosis and a treatment plan just for you. Only a doctor familiar with your medical history, the type and stage and other features of the cancer, the treatments chosen and the response to treatment can put all of this information together with survival statistics to arrive at a prognosis and chances of survival. […] The following are prognostic and predictive factors for melanoma skin cancer. […] The thickness of the primary tumour refers to how many layers of skin it has grown into. It is an important prognostic factor because it helps predict the risk that the cancer will spread. Thicker tumours have a higher risk of spreading to other parts of the body and coming back (recurring) after treatment. The thicker the tumour, the poorer the prognosis.
#1 Prognosis and survival for melanoma skin cancer | Canadian Cancer Society
https://cancer.ca/en/cancer-information/cancer-types/melanoma-skin/prognosis-and-survival
An ulcerated primary tumour has a less favourable prognosis than one that isn’t ulcerated. Ulceration increases the risk that the cancer will spread to other parts of the body and come back after treatment. […] An increased mitotic rate is linked with a poor prognosis. […] If cancer has spread to nearby lymph nodes, the prognosis is poorer. The more lymph nodes that contain cancer, the poorer the prognosis. […] Having melanoma on the arms or legs (extremities) has a better prognosis than having melanoma on the central part of the body (trunk), head or neck. […] Women tend to have a better prognosis than men when diagnosed with melanoma. […] Overall, people who are older have a poorer prognosis. […] Nodular melanoma has a poor prognosis because it grows down into the layers of the skin (vertical growth pattern) and tends to be thick when diagnosed. […] Melanoma has a poor prognosis when it spreads to other parts of the body (called distant metastases), such as the lung, the liver or the brain. […] For metastatic melanoma, a high lactate dehydrogenase (LDH) level in the blood has a poorer prognosis than when the LDH level is normal.
#1 Melanoma epidemiology, biology and prognosis
https://pmc.ncbi.nlm.nih.gov/articles/PMC4041476/
Moreover, at each tumour thickness it has been demonstrated that the presence of epithelial ulceration in the primary results in a worse prognosis than if there is no ulceration. […] These two features (tumour thickness and ulceration) are arguably the most powerful independent prognostic factors for cutaneous melanoma. […] A third significant pathological feature is the mitotic rate; a rate of 20 mitosis/mm2 results in a 10-year survival of approximately 48% relative to 93% in those individuals with 1 mitosis/mm2. […] The site of the primary also has important prognostic implications; those arising centrally (trunk, head and neck) tend to carry a worse prognosis than those arising on the limbs (lower upper). […] Additionally, cutaneous melanoma can metastasise to lymph nodes. The presence of lymph-node disease has adverse prognostic implications, with further variation depending on the burden of nodal disease both in terms of micrometastatic versus macroscopic disease and the number of lymph nodes involved.
#1 Melanoma epidemiology, biology and prognosis
https://pmc.ncbi.nlm.nih.gov/articles/PMC4041476/
The presence of microscopic lymph-node disease results in 10-year survival rates of 63%, but if macroscopic disease is present this drops to 47%. […] Similarly, there is a 10% 5-year survival deterioration with an increase in the number of nodes involved (from 1 to 3); for those with macroscopic metastases this increased risk is independent of other primary tumour characteristics. […] Metastases to other sites have adverse prognostic implications. Satellite cutaneous lesions reduce survival by a similar proportion to lymph-node metastases, with worsening prognosis with metastases to the lung and further deterioration with any other organ involvement. […] In terms of patient characteristics, it is well established that age is an independent prognostic factor, with worsening outcome associated with increasing age.
#1 Melanoma epidemiology, biology and prognosis
https://pmc.ncbi.nlm.nih.gov/articles/PMC4041476/
Interestingly, for early-stage (III) melanoma, female gender also has positive prognostic implications, possibly related to the higher number of thin, non-ulcerated, extremity lesions diagnosed in women. […] The histopathological factors previously discussed are more prognostically significant than gender. […] With regard to biochemical features, serum lactate dehydrogenase (LDH) is well recognised as an independent prognostic factor in cutaneous melanoma; in multivariate analysis a raised LDH level predicts approximately 50% lower survival rates in patients with distant metastases. […] Other serum prognostic biomarkers have also been studied; the most promising, S100 protein levels, correlate with survival in patients with resected locoregional disease, with high levels predicting a significantly worse outcome than with normal levels.
#1 Melanoma epidemiology, biology and prognosis
https://pmc.ncbi.nlm.nih.gov/articles/PMC4041476/
The increased use of gene expression profiling is also providing further genetic prognostic clues. The BRAF gene mutation which as previously described is integral to melanoma pathogenesis has been investigated as a prognostic marker too. […] It appears to be linked to known prognostic factors such as age and site of primary, whilst also being unrelated to factors such as site of metastasis and LDH. […] In advanced disease, meta-analyses have demonstrated that the presence of a BRAF mutation is independently associated with a worse survival outcome.
#1 Survival statistics for melanoma skin cancer | Canadian Cancer Society
https://cancer.ca/en/cancer-information/cancer-types/melanoma-skin/prognosis-and-survival/survival-statistics
Survival statistics for cancer are very general estimates and must be interpreted very carefully. Because these statistics are based on the experience of groups of people, they cannot be used to predict a particular persons chances of survival. […] In Canada, the 5-year net survival for melanoma skin cancer is 89%. This means that, on average, about 89% of people diagnosed with melanoma will live for at least 5 years. […] Survival varies with each stage of melanoma. Generally, the earlier melanoma is diagnosed and treated, the better the outcome. Most melanomas are found at an early stage and this type of cancer often responds well to cancer treatment. […] Melanoma-specific survival is an estimate of the percentage of people with melanoma who have not died from the disease in a certain period of time since diagnosis.
#1 Survival for melanoma skin cancer | Cancer Research UK
https://www.cancerresearchuk.org/about-cancer/melanoma/survival
Almost everyone (around 100%) with stage 1 melanoma skin cancer will survive their cancer for 5 years or more after they are diagnosed. […] Around 85 in 100 people (around 85%) with stage 2 melanoma skin cancer will survive their cancer for 5 years or more after diagnosis. […] Almost 75 in 100 people (almost 75%) with stage 3 melanoma skin cancer will survive their cancer for 5 years or more after they are diagnosed. […] More than 55 out of 100 people (more than 55%) survived for 6 and a half years or more. […] Around 45 out of 100 people (around 45%) survived for 6 and a half years or more. […] almost all people (almost 100%) will survive their melanoma for 1 year or more […] almost 95 out of every 100 people (almost 95%) will survive their melanoma for 5 years or more […] more than 85 in 100 people (more than 85%) will survive their melanoma for 10 years or more. […] Your outlook depends on the stage of the cancer when it was diagnosed. […] Age can also affect outlook and younger people have a better prognosis than older people.
#1 Melanoma: Your Chances for Recovery (Prognosis) | Saint Luke’s Health System
https://www.saintlukeskc.org/health-library/melanoma-your-chances-recovery-prognosis
When found early and treated properly, melanoma is highly curable. […] The 5-year survival rate is around 97% for Stage IA. The 10-year survival rate is around 95%. […] The 5-year survival rate is around 15% to 20% for Stage IV. The 10-year survival rate is 10% to 15%. This rate is higher if the cancer has spread only to the skin or distant lymph nodes and not to vital organs. […] You can ask your healthcare provider about survival rates and what you might expect. But remember that statistics are based on large groups of people. They cannot be used to say what will happen to you.
#1 Survival Rates – AIM at Melanoma Foundation
https://www.aimatmelanoma.org/melanoma-101/how-melanoma-is-diagnosed/prognosis/
The five-year survival rate for Stage IV melanoma wasâone decade agoâabout 15% to 20%. The ten-year survival rate was about 10% to 15%. Newer data about Stage IV survival suggest an improved survival rate: Early data from clinical trials of targeted therapy and combination immune therapy have demonstrated five-year survival rates ranging from 34-52% for this select group of patients. […] It is important to remember that statistics on the survival rates for people with melanoma are based on annual data from past cases and over multi-year timeframes. Survival rates do not predict your survival. There are patients who survive Stage IV melanoma long-term. The survival prognosis is better if the melanoma has spread only to distant parts of the skin or distant lymph nodes rather than to other organs, and if the lactate dehydrogenase (LDH) level is normal.
#1 Regression in primary cutaneous melanoma: etiopathogenesis and clinical significance | Laboratory Investigation
https://www.nature.com/articles/labinvest20178
Though not required currently for staging, regression is a histopathologic parameter typically reported upon diagnosis of an invasive primary cutaneous melanoma. […] The studies examining the prognostic significance of regression in patient outcome have yielded controversial findings; likely because the definition and assessment of regression have not been consistent, in addition to subjectivity of pathologists interpretation. […] Breslow thickness is the most important histologic parameter predicting outcome in primary cutaneous melanomas. […] Lesions with thickness 1.00mm usually have a very good prognosis; more than 95% of patients with such thin melanomas are alive at 10 years after diagnosis. […] Regression may be an important prognostic indicator, since several cases of melanoma presenting initially as regional metastases (eg, cutaneous or lymph node) have been documented in the setting of complete regression of the primary melanoma or an unknown primary tumor, suggesting an association between regression and metastasis.
#1 Regression in primary cutaneous melanoma: etiopathogenesis and clinical significance | Laboratory Investigation
https://www.nature.com/articles/labinvest20178
Thus, the prognostic impact of regression in patients with melanoma remains controversial. […] The prognostic significance of regression in primary melanoma has been controversial for many years. […] Several studies have failed to show a correlation between regression and patient outcome. […] In contrast, other studies have indicated that the presence of regression in melanoma was associated with a poor prognosis. […] On the other hand, additional studies have suggested that regression indicates a favorable outcome. […] In a recent study of 1349 cutaneous melanomas, however, Morris et al showed that regression correlated with decreased local and systemic recurrence. […] In their large study of cutaneous stage I and stage II melanomas, Shaw et al reported that regression was present in all 28 cases of thin melanoma (Breslow thickness 0.76mm) that presented with concurrent regional lymph node metastases (stage II), suggesting an association between regression and lymph node metastasis.
#1 Prospective multicenter study using artificial intelligence to improve dermoscopic melanoma diagnosis in patient care | Communications Medicine
https://www.nature.com/articles/s43856-024-00598-5
Early detection of melanoma, a potentially lethal type of skin cancer with high prevalence worldwide, improves patient prognosis. […] As the algorithm exhibits a significant performance advantage on our heterogeneous dataset exclusively comprising melanoma-suspicious lesions, AI may offer the potential to support dermatologists, particularly in diagnosing challenging cases. […] Overall, at the predetermined 85% sensitivity threshold, ADAE showed higher balanced accuracy than dermatologists originally diagnosing the lesions (ADAE: 0.798 vs. dermatologists: 0.781) with significantly higher sensitivity (0.922 vs. 0.734), but significantly lower specificity (0.673 vs. 0.828). […] Our findings suggest that AI algorithms may be better suited than dermatologists for diagnosing skin lesions of younger patients or patients with lesions on the head or neck. […] In conclusion, ADAE showed better performance than dermatologists in terms of balanced accuracy and sensitivity, but worse specificity.
#1 Predicting the clinical outcome of melanoma using an immune-related gene pairs signature | PLOS One
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0240331
A signature consisted of 33 IRGPs was established which was significantly associated with patients survival in the TCGA-SKCM dataset (P = 2.01016, Hazard Ratio (HR) = 4.220 (2.909 to 6.122)). […] The results of the present study support the IRGPs signature as a promising marker for prognosis prediction in melanoma. […] The IRGPs signature remained an independent predictive value of OS in both the univariate and multivariate Cox analysis in the validation dataset (P0.01). […] The IRGPs signature remained an independent predictive value of OS in both the univariate and multivariate Cox analysis in this validation dataset (P0.01). […] The signature should also be optimized with more rigorous algorithms and validated with more datasets from different platforms.
#1 Predicting survival in melanoma patients treated with concurrent targeted- or immunotherapy and stereotactic radiotherapy | Radiation Oncology | Full Text
https://ro-journal.biomedcentral.com/articles/10.1186/s13014-020-01558-8
Using the measures proposed by Sperduto and colleagues, we were unable to validate the molGPA score. However, when using the factors cumulative brain metastasis volume, timing of brain metastases development and type of systemic treatment, survival was stratified in a statistically significant manner. […] The VTS score was significantly associated with OS with a median OS in the three groups of 5.1, 18.9 and 34.5months, respectively. […] In conclusion, this study shows for the first time, that the molGPA score has to be used with caution for the rapidly growing cohort of melanoma patients treated with SRT concurrent with immuno- or targeted therapies for brain metastases. Factors such as cumulative brain metastasis volume, timing of metastases and type of systemic treatment should be taken into account in this cohort.
#1 Survival Rates – AIM at Melanoma Foundation
https://www.aimatmelanoma.org/melanoma-101/how-melanoma-is-diagnosed/prognosis/
Melanoma can be treated most effectively in its early stages when it is still confined to the top layer of the skin (epidermis). The deeper a melanoma penetrates into the lower layers of the skin (dermis), the greater the risk that it could or has spread to nearby lymph nodes or other organs. In recent years, clinical breakthroughs have led to new treatments that continue to improve the prognosis for people with advanced melanoma. […] It is important to remember that survival rates do not predict an individualâs survival. Every person and every case are different, and many factors contribute to an individualâs survival. Itâs also important to remember that new and successful treatments have emerged over the last few years, and survival rates have increased in Stage III and Stage IV melanoma.
#1 Survival statistics for melanoma skin cancer | Canadian Cancer Society
https://cancer.ca/en/cancer-information/cancer-types/melanoma-skin/prognosis-and-survival/survival-statistics
Talk to your doctor about your prognosis. A prognosis depends on many factors, including: your health history, the type of cancer, where the cancer started on the skin, the stage, including how thick the tumour is and if there is broken skin with an open wound (called ulceration), the treatments chosen, how the cancer responds to treatment. […] Only a doctor familiar with these factors can put all of this information together with survival statistics to arrive at a prognosis.
#1 Melanoma: Your Chances for Recovery (Prognosis) | Saint Luke’s Health System
https://www.saintlukeskc.org/health-library/melanoma-your-chances-recovery-prognosis
Prognosis is the word your health care team may use to describe your chances of recovering from cancer. Or it may mean your likely outcome from cancer and cancer treatment. […] A doctor who is most familiar with your health is in the best position to discuss your prognosis with you and explain what the statistics may mean in your case. At the same time, you should keep in mind that your prognosis can change. Cancer and cancer treatment outcomes are hard to predict. […] If your cancer is likely to respond well to treatment, your doctor will say you have a favorable prognosis. This means you’re expected to live many years and may even be cured. If your cancer is likely to be hard to control, your prognosis may be less favorable. The cancer may shorten your life. […] Your prognosis depends on: The type and location of the cancer, The stage of the cancer, Your overall health, Your treatment decisions, How well your cancer responds to treatment.
#1 Azthena logo with the word Azthena
https://www.news-medical.net/health/Melanoma-Prognosis.aspx
It is evident that the 5-year survival rate is lower with more advanced disease, as dictated by the diagnostic staging. In stage IV of the disease when there are distant metastases, the cancer is generally considered to be incurable and the median survival is less than once a year, although some patients live for several years.
#2 Melanoma epidemiology, biology and prognosis
https://pmc.ncbi.nlm.nih.gov/articles/PMC4041476/
Prognostic factors in cutaneous melanoma have been closely studied; they include histopathological characteristics, patient characteristics, biochemical measures and most recently genetic mutations. Each of these will be considered in turn. […] The American Joint Committee on Cancer (AJCC) staging system is globally acknowledged as an invaluable tool in predicting outcomes for patients diagnosed with melanoma. It is based on data derived from analysis of tens of thousands of cutaneous melanoma patients; the current seventh edition was introduced early in 2010 and incorporated new factors not previously used in the estimation of melanoma prognosis. […] Histopathological features logically form the main criteria for determining prognosis. Increasing thickness of the cutaneous primary correlates with worsening survival outcomes, dropping from 96% 10-year survival for lesions 1 mm, to 54% for lesions 4 mm; even for lesions 1 mm in thickness, there is further deterioration in outcome between lesions 0.25 mm thickness and those 0.75 mm.
#2 Melanoma epidemiology, biology and prognosis
https://pmc.ncbi.nlm.nih.gov/articles/PMC4041476/
Moreover, at each tumour thickness it has been demonstrated that the presence of epithelial ulceration in the primary results in a worse prognosis than if there is no ulceration. […] These two features (tumour thickness and ulceration) are arguably the most powerful independent prognostic factors for cutaneous melanoma. […] A third significant pathological feature is the mitotic rate; a rate of 20 mitosis/mm2 results in a 10-year survival of approximately 48% relative to 93% in those individuals with 1 mitosis/mm2. […] The site of the primary also has important prognostic implications; those arising centrally (trunk, head and neck) tend to carry a worse prognosis than those arising on the limbs (lower upper). […] Additionally, cutaneous melanoma can metastasise to lymph nodes. The presence of lymph-node disease has adverse prognostic implications, with further variation depending on the burden of nodal disease both in terms of micrometastatic versus macroscopic disease and the number of lymph nodes involved.
#2 Prognosis and survival for melanoma skin cancer | Canadian Cancer Society
https://cancer.ca/en/cancer-information/cancer-types/melanoma-skin/prognosis-and-survival
An ulcerated primary tumour has a less favourable prognosis than one that isn’t ulcerated. Ulceration increases the risk that the cancer will spread to other parts of the body and come back after treatment. […] An increased mitotic rate is linked with a poor prognosis. […] If cancer has spread to nearby lymph nodes, the prognosis is poorer. The more lymph nodes that contain cancer, the poorer the prognosis. […] Having melanoma on the arms or legs (extremities) has a better prognosis than having melanoma on the central part of the body (trunk), head or neck. […] Women tend to have a better prognosis than men when diagnosed with melanoma. […] Overall, people who are older have a poorer prognosis. […] Nodular melanoma has a poor prognosis because it grows down into the layers of the skin (vertical growth pattern) and tends to be thick when diagnosed. […] Melanoma has a poor prognosis when it spreads to other parts of the body (called distant metastases), such as the lung, the liver or the brain. […] For metastatic melanoma, a high lactate dehydrogenase (LDH) level in the blood has a poorer prognosis than when the LDH level is normal.
#2 Melanoma epidemiology, biology and prognosis
https://pmc.ncbi.nlm.nih.gov/articles/PMC4041476/
The presence of microscopic lymph-node disease results in 10-year survival rates of 63%, but if macroscopic disease is present this drops to 47%. […] Similarly, there is a 10% 5-year survival deterioration with an increase in the number of nodes involved (from 1 to 3); for those with macroscopic metastases this increased risk is independent of other primary tumour characteristics. […] Metastases to other sites have adverse prognostic implications. Satellite cutaneous lesions reduce survival by a similar proportion to lymph-node metastases, with worsening prognosis with metastases to the lung and further deterioration with any other organ involvement. […] In terms of patient characteristics, it is well established that age is an independent prognostic factor, with worsening outcome associated with increasing age.
#2 Melanoma epidemiology, biology and prognosis
https://pmc.ncbi.nlm.nih.gov/articles/PMC4041476/
Interestingly, for early-stage (III) melanoma, female gender also has positive prognostic implications, possibly related to the higher number of thin, non-ulcerated, extremity lesions diagnosed in women. […] The histopathological factors previously discussed are more prognostically significant than gender. […] With regard to biochemical features, serum lactate dehydrogenase (LDH) is well recognised as an independent prognostic factor in cutaneous melanoma; in multivariate analysis a raised LDH level predicts approximately 50% lower survival rates in patients with distant metastases. […] Other serum prognostic biomarkers have also been studied; the most promising, S100 protein levels, correlate with survival in patients with resected locoregional disease, with high levels predicting a significantly worse outcome than with normal levels.
#2 Melanoma epidemiology, biology and prognosis
https://pmc.ncbi.nlm.nih.gov/articles/PMC4041476/
The increased use of gene expression profiling is also providing further genetic prognostic clues. The BRAF gene mutation which as previously described is integral to melanoma pathogenesis has been investigated as a prognostic marker too. […] It appears to be linked to known prognostic factors such as age and site of primary, whilst also being unrelated to factors such as site of metastasis and LDH. […] In advanced disease, meta-analyses have demonstrated that the presence of a BRAF mutation is independently associated with a worse survival outcome.
#2 Melanoma: Your Chances for Recovery (Prognosis) | Saint Luke’s Health System
https://www.saintlukeskc.org/health-library/melanoma-your-chances-recovery-prognosis
When found early and treated properly, melanoma is highly curable. […] The 5-year survival rate is around 97% for Stage IA. The 10-year survival rate is around 95%. […] The 5-year survival rate is around 15% to 20% for Stage IV. The 10-year survival rate is 10% to 15%. This rate is higher if the cancer has spread only to the skin or distant lymph nodes and not to vital organs. […] You can ask your healthcare provider about survival rates and what you might expect. But remember that statistics are based on large groups of people. They cannot be used to say what will happen to you.
#2 Regression in primary cutaneous melanoma: etiopathogenesis and clinical significance | Laboratory Investigation
https://www.nature.com/articles/labinvest20178
Though not required currently for staging, regression is a histopathologic parameter typically reported upon diagnosis of an invasive primary cutaneous melanoma. […] The studies examining the prognostic significance of regression in patient outcome have yielded controversial findings; likely because the definition and assessment of regression have not been consistent, in addition to subjectivity of pathologists interpretation. […] Breslow thickness is the most important histologic parameter predicting outcome in primary cutaneous melanomas. […] Lesions with thickness 1.00mm usually have a very good prognosis; more than 95% of patients with such thin melanomas are alive at 10 years after diagnosis. […] Regression may be an important prognostic indicator, since several cases of melanoma presenting initially as regional metastases (eg, cutaneous or lymph node) have been documented in the setting of complete regression of the primary melanoma or an unknown primary tumor, suggesting an association between regression and metastasis.
#2 Regression in primary cutaneous melanoma: etiopathogenesis and clinical significance | Laboratory Investigation
https://www.nature.com/articles/labinvest20178
Thus, the prognostic impact of regression in patients with melanoma remains controversial. […] The prognostic significance of regression in primary melanoma has been controversial for many years. […] Several studies have failed to show a correlation between regression and patient outcome. […] In contrast, other studies have indicated that the presence of regression in melanoma was associated with a poor prognosis. […] On the other hand, additional studies have suggested that regression indicates a favorable outcome. […] In a recent study of 1349 cutaneous melanomas, however, Morris et al showed that regression correlated with decreased local and systemic recurrence. […] In their large study of cutaneous stage I and stage II melanomas, Shaw et al reported that regression was present in all 28 cases of thin melanoma (Breslow thickness 0.76mm) that presented with concurrent regional lymph node metastases (stage II), suggesting an association between regression and lymph node metastasis.
#2 Predicting the clinical outcome of melanoma using an immune-related gene pairs signature | PLOS One
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0240331
A signature consisted of 33 IRGPs was established which was significantly associated with patients survival in the TCGA-SKCM dataset (P = 2.01016, Hazard Ratio (HR) = 4.220 (2.909 to 6.122)). […] The results of the present study support the IRGPs signature as a promising marker for prognosis prediction in melanoma. […] The IRGPs signature remained an independent predictive value of OS in both the univariate and multivariate Cox analysis in the validation dataset (P0.01). […] The IRGPs signature remained an independent predictive value of OS in both the univariate and multivariate Cox analysis in this validation dataset (P0.01). […] The signature should also be optimized with more rigorous algorithms and validated with more datasets from different platforms.
#2 Survival statistics for melanoma skin cancer | Canadian Cancer Society
https://cancer.ca/en/cancer-information/cancer-types/melanoma-skin/prognosis-and-survival/survival-statistics
Talk to your doctor about your prognosis. A prognosis depends on many factors, including: your health history, the type of cancer, where the cancer started on the skin, the stage, including how thick the tumour is and if there is broken skin with an open wound (called ulceration), the treatments chosen, how the cancer responds to treatment. […] Only a doctor familiar with these factors can put all of this information together with survival statistics to arrive at a prognosis.
#2 Survival statistics for melanoma skin cancer | Canadian Cancer Society
https://cancer.ca/en/cancer-information/cancer-types/melanoma-skin/prognosis-and-survival/survival-statistics
Survival statistics for cancer are very general estimates and must be interpreted very carefully. Because these statistics are based on the experience of groups of people, they cannot be used to predict a particular persons chances of survival. […] In Canada, the 5-year net survival for melanoma skin cancer is 89%. This means that, on average, about 89% of people diagnosed with melanoma will live for at least 5 years. […] Survival varies with each stage of melanoma. Generally, the earlier melanoma is diagnosed and treated, the better the outcome. Most melanomas are found at an early stage and this type of cancer often responds well to cancer treatment. […] Melanoma-specific survival is an estimate of the percentage of people with melanoma who have not died from the disease in a certain period of time since diagnosis.
#3 Regression in primary cutaneous melanoma: etiopathogenesis and clinical significance | Laboratory Investigation
https://www.nature.com/articles/labinvest20178
Thus, the prognostic impact of regression in patients with melanoma remains controversial. […] The prognostic significance of regression in primary melanoma has been controversial for many years. […] Several studies have failed to show a correlation between regression and patient outcome. […] In contrast, other studies have indicated that the presence of regression in melanoma was associated with a poor prognosis. […] On the other hand, additional studies have suggested that regression indicates a favorable outcome. […] In a recent study of 1349 cutaneous melanomas, however, Morris et al showed that regression correlated with decreased local and systemic recurrence. […] In their large study of cutaneous stage I and stage II melanomas, Shaw et al reported that regression was present in all 28 cases of thin melanoma (Breslow thickness 0.76mm) that presented with concurrent regional lymph node metastases (stage II), suggesting an association between regression and lymph node metastasis.