Introduction: Melanoma, a neoplasm of melanocytes is the most aggressive and life-threatening skin cancer. The incidence of it is higher in fair skinned people as the Ultraviolet-light exposure is the most important risk factor with the malignant transformation of the nevi. So here we aimed to determine the clinical and histopathological findings of our Melanoma cases. Method: We reviewed the tumors of the patients who received the diagnosis of Melanoma at our Pathology Laboratory, between 2011 and 2018 retrospectively. Results and Discussion: There were 43 skin Melanoma cases. 21(48.8%) of the patients were female, 22(51.2%) were male. The median-age in females was 68, while 64 in males. 35(81.4%) of the 43 cases were Nodular Melanoma(NM), 3(7%) were Superficial-spreading melanoma(SSM) and 5(11.6%) were Melanoma-in-situ(MIS). None of the SSMs and MISs had metastasis to anywhere. 7(20%) of the NMs had lymph-node and 3(8.6%) had soft tissue metastasis at the time of diagnosis. 4 developed lung, brain, stomach and nasopharinx metastases in the following 2 years. The ratio of the Clark Level 2,3,4,5 of NMs were 11.4%, 28.6%, 45.7% and 14.3% respectively. Most of the metastatic cases were Clark Level 3 or 4. This study showed that Melanoma is generally diagnosed at WHO-Stage 2 or 3 and this cause worse prognosis as the cure rates depend greatly on the stage. Conclusion: As a result it's very important to self-examine the existing nevi on our skin in order to detect the early malignant transformation to Melanoma and protect our skin from Ultraviolet-light.
Melanoma is a malignant neoplasm of melanocytes. It accounts for 4% and
We reviewed the slides and the clinical data of the patients
Who received the diagnosis of Melanoma at Pathology Laboratory of Muğla Sıtkı Koçman University Education and
Research Hospital, between 20
This Project was evaluated by Muğla Sıtkı Koçman University Research and Publication Ethics Committee with 180150/18 registration number and it was approved in terms of scientific researches and patient ethics.
In statistical analysis of data, mean and standard deviation for continuous variables and percentages for categorical variables were used. Descriptive statistics and categorical variables were given as frequencies (percentages).
There were 43 cutaneous Melanoma cases. 21(48.8%) of the patients were female, 22(51.2%) of them were male. The median age at the time of diagnosis in females was 68, while 64 in males. Other detailed results of the parameters evaluated are listed in the
Parameters evaluated in patients with Cutaneous Melanoma
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Nodular Melanoma | 35 | 81.4 |
Superficial-spreading melanoma | 3 | 7 | |
Melanoma-in-situ | 5 | 11.6 | |
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- | 5 | 11.63 |
<1 | 2 | 4.65 | |
1-2 | 9 | 20.93 | |
>2-≤4 | 13 | 30.23 | |
>4 | 14 | 32.56 | |
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- | 5 | 11.63 |
1 | 1 | 2.33 | |
2 | 5 | 11.63 | |
3 | 12 | 20.90 | |
4 | 16 | 37.21 | |
5 | 4 | 9.30 | |
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Absent (≤1/1mm
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6 | 13.95 |
Present (>1/1mm
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37 | 86.05 | |
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Absent | 33 | 76.74 |
Present | 10 | 23.26 | |
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Absent | 34 | 79.07 |
Present | 9 | 20.93 | |
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Absent | 13 | 30.23 |
Nonbrisk | 11 | 25.58 | |
Brisk | 19 | 44.19 | |
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Absent | 38 | 88.37 |
Present | 5 | 11.63 | |
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43 | 100 |
Most of the cases were Nodular Melanoma(NM), 3 were Superficial-spreading melanoma(SSM) and 5 were Melanoma-in-situ(MIS). None of the SSMs and MISs had metastasis to anywhere.
7(20%) of the NMs had lymph-node metastasis (
Among these lymph-node metastatic patients,
The features of Nodular Melanoma cases with lymph-node metastasis at the time of diagnosis.
case | Age | Breslow thickness(mm) | Cark level | Lymphovascular invasion | Peri/intraneural invasion | Other synchronous metastasis | Metachronous metastasis | Additional disease |
1 | 63 | 10 | 5 | + | - | |||
2 | 73 | 9 | 5 | + | - | |||
3 | 68 | 15 | 5 | + | + | -Nasopharinx | ||
4 | 75 | 13 | 5 | + | + | -Stomach | ||
5 | 72 | 14 | 5 | + | + | -Brain | ||
6 | 60 | 8 | 4 | + | _ | |||
7 | 31 | 10 | 5 | + | + | -Lung-Soft tissue | Non-Hodgkin Lymphoma |
Also among these lymph-node metastatic patients, 1 patient had synchronous brain metastasis and 2 patients developed metachronous metastases to the stomach and nasopharinx in the following 2 years (
When all patients are considered; most of the tumors had higher Breslow thickness than 2mm (62.79%) and the average Breslow tumor thickness was 4.75mm in NMs. Also most of the tumors had 3 or higher Clark Level (67.41%) at the time of diagnosis.
In our study we presented that Cutaneous melanoma is predominantly a disease of older people and is seen more common in males especially in our geographical region in paralel to the study of Ozgen(
important independent prognostic parameter. Thin melanomas tend to have brisk response while thick tumors frequently have no lymphocytic response as we found in our study(7,
This study showed that Melanoma is generally diagnosed at advanced stage and this cause worse prognosis as the cure rates depend greatly on the stage. So as a result it’s very important to self-examine our skin, detect the newly emerging lesions and the existing nevi on our skin in order to diagnose the Melanomas earlier. Also another very important attitude is to protect our skin from Ultraviolet-light especially in the countries with excess sun exposure like our country; Turkey.
Chang C, Murzaku EC, Penn L, Abbasi NR, Davis PD, Berwick M, et al. More skin, more sun, more tan, more melanom. Am J Public Health. 2014;104(11):92-9.
Siegel RL, Miller KD, Jemal A. Cancer statistics, 2015. CA Cancer J Clin. 2015;65(1):5-29.
Calonje E, Brenn T, Lazar A, McKee PH. Malignant Melanoma in McKee’s Pathology of the skin. Elsevier Saunders, 4th ed. 2012, Philadelphia. P:1221-1267.