Prognostic significance of the patient's sex, tumor site, and mitotic rate in thin (less than or equal to 1.5 mm) melanoma.

Patients who died of a melanoma thinner than 1.5 mm within 96 months (group 1, n = 60) were compared with those having a tumor of the same thickness who had not died in this time period (Group 2, n = 300). Both groups were investigated with respect to differences in patient sex and age and to thickness, diameter, exophytic growth, and site of the melanoma as well as the number of mitoses/mm2 of tumor area. Relatively speaking, more men than women died of a thin melanoma: in Group 1 (deceased) there were 32 men and 28 women, in Group 2 (alive) 58 men and 242 women. The better survival rate of females did not depend on the difference in the predominating melanoma locations (female face and legs; male trunk): In both sites, on the legs and on the trunk, women had a significantly higher 8-year survival rate than men with equally thick tumors. Furthermore, melanomas on the arms and legs of females had a better prognosis than those on the trunk and face. Both the patient's sex and the tumor site seem to influence the survival of melanoma patients. Only in men was the median of mitoses/mm2 of tumor area found to be higher in the first group (2.2) than in the second group (0.75). In women, no marked difference in the mitotic count was found (Group 1:1.1; Group 2:1.15).

Histology of congenital nevi during the first year of life. A study by conventional and electron microscopy.

We studied 14 biopsies of congenital melanocytic nevi of children up to 1 year of age. In 11 biopsies we found two different types of melanocytic cells. In the reticular dermis, they were small cells. They had small nuclei, little cytoplasm, and no detectable pigment. They did not come in nests, but were scattered between the collagen bundles. The other type of cells was found within the epidermis or closely under it. These cells were large and round, and had abundant cytoplasms and evenly distributed melanin. Sometimes these cells were arranged in nests and in two moles they were also found in the epithelia of follicles. In all of these biopsies (with three exceptions) the superficial, large pigmented cells were separated from the deep, small, nonpigmented ones by a zone of tissue without any melanocytic cell. Early in life both types of cells are clearly separated, and the superficial ones are few. At later ages the superficial large cells are found in increased numbers, whereas the number of the deep ones does not change with age.

Prognostic groups of patients with stage I melanoma.

The thickness of melanomas, presence or absence of ulceration, and the sex of the patient were the three dominant variables affecting the eight-year survival of 1,191 patients with clinical stage I melanoma in the prospective German melanoma group. With regard to these variables, three prognostic groups were defined representing 30%, 9%, and 61% of the patients, respectively. The good prognosis group (93% of patients surviving eight years) consisted of women with melanomas that were 1.5 mm thick or less. The intermediate prognosis group (78% of patients surviving eight years) consisted of men with nonulcerated melanomas that were 1.5 mm thick or less. The poor prognosis group (46% of patients surviving eight years) consisted of all who were left with remaining melanomas, ie, all those with melanomas thicker than 1.5 mm, and in men ulcerated tumors that were 1.5 mm thick or less.

Verrucous-keratotic variations of malignant melanoma: a clinicopathological study.

Verrucous-keratotic forms of malignant melanoma occur more commonly in women and favor the extremities, but may occur on any anatomic site. Seventy-one percent of such melanomas are situated on the upper and lower extremities. Although two-thirds of these neoplasms can be assigned a histologic pattern according to the classification of Clark, one-third of these melanomas with marked verrucous hyperplasia and hyperkeratosis of the epidermis do not fit into his classification. The neoplastic cells proliferate mostly at the dermo-epidermal interface rather than in the upper reaches of the epidermis. Nodules are practically never formed. Most of the neoplasms are elevated, but like plateaus. They usually show only sparse, mononuclear inflammatory-cell infiltration. Clinically, verrucous-keratotic melanomas resemble one another in that they are small, slightly elevated, devoid of nodules, and without areas of regression. The prognosis of verrucous-keratotic melanomas does not differ from that of nonverrucous melanomas matched for sex, anatomic site, and thickness of the neoplasm.