Melanoma thickness: Breslow index seems more accurate than Clark index as prognostic factor. Patients with melanomas 1 mm thick have a 20% mortality at 10 years, while patients with tumor thickness > 4 mm have a 50% mortality at 10 years.
Ulceration: ulcerated melanomas typically have a greater thickness than non-ulcerated. The tendency to metastasize of these lesions is high
Mitotic rate: The number of mitoses per square millimeter, the greater the number of mitosis and the worse the prognosis. Patients with more than 6 mitoses seem to have a higher mortality at 5 years. Ì
Regression: is the replacement of tumor tissue with fibrosis, degenerated cells, lymphocitic proliferation and telangiectasias. One study confirmed that in the case of melanomas <1 mm regression was present in 42% of melanomas that metastasize and 5% of melanomas which did not metastasize.
Lymphocytic infiltrate: lymphocytic infiltration of the tumor is believed to represent the immune response to cancer cells, this response is measured by the level of lymphocytic infiltrate at the base of the vertical growth of melanoma and sometimes it is divided into: brisk, nonbrisk, absent.
Angiolymphatic invasion: Some studies have shown a correlation between depth of angiolymphatic invasion and melanoma. The presence of invasion angiolymphatic in a primary melanoma with vertical growth phase reduces survival by 40% at 8 years.
Microscopic satellitosis: they are discrete tumor nests greater than 0.05 mm in diameter.
Sentinel lymph node: the 10-year survival drops to 50% in case of 1 positive sentinel lymph node 1 if positive nodes are 4 it drops to 20%.
Sex: various studies have shown a better prognosis in women
Age: Older patients present more frequently with thicker and ulcerated melanomas and many studies have reported age to be an independent prognostic factor
Tumor location: limb melanomas have a better prognosis than melanomas of the trunk and head. The subungual melanomas have a worse prognosis than limb melanoma. Ear and neck sites have a worse prognosis.
BRAF gene mutation: it is the most frequent mutation in human melanoma, BRAF mutations were associated with slower growth of the tumor
Lactate dehydrogenase (LDH) serum levels is one of the factors most predictive of decreased survival
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