Despite\u00a0the increased incidence of melanoma, the prognosis has improved markedly\u00a0in the last 20 years and this is due to an early diagnosis, in fact\u00a0more and more superficial melanomas are removed. The thickness of the neoplasm must be considered among the most important\u00a0prognostic factors. However, other elements also help to formulate a\u00a0prognosis in patients with melanoma.<\/p>\n
Thickness of the melanoma:<\/strong>\u00a0Breslow’s index seems more accurate than Clark’s. The Breslow index is measured from the epidermal surface or from the base of the ulcer and is performed with a calibrated ocular micrometer. Patients with 1 mm thick melanomas have 20% mortality at 10 years, while patients with tumors > 4 mm thick have 50% mortality at 10 years. The Breslow index is an\u00a0important prognostic index in mucosal tumors.<\/p>\n Ulceration:<\/strong> ulcerated lesions are generally thicker than non-ulcerated ones. The ulcerated lesions obviously appear thinner\u00a0because the superficial part of the lesion has been eliminated. The\u00a0tendency of these lesions to metastasize is high. The 5-year survival of stage I-II melanomas decreases from 80% to 55% in the presence of ulceration and in stage III from 53% to 12%.<\/p>\n Mitosis:<\/strong>\u00a0it is the number of mitoses per square millimeter; the greater the number of mitoses, the worse the prognosis. Various studies have shown that with the same thickness, the prognosis is worse if the mitoses are greater. Patients with more than 6 mitoses appear to have a 5-year relative mortality 11.4 times greater. Normally, a distinction is made between low mitotic activity = 1 mitosis\/mm2, moderate mitotic activity = 1-6 mitosis\/mm2; high mitotic activity = > of 6 mitoses\/mm2. A marker\u00a0of mitotic activity can also be obtained from nuclear factors\u00a0which serve as indicators of proliferative activity. MIB-1 which is\u00a0a monoclonal antibody that recognizes Ki-67 epitope. Ramsey saw a reduction in survival in thick Breslow >4 mm Stage I melanomas with high reactivity to MIB-1. Furthermore, a\u00a0progressively greater reactivity of MIB-1 by benign nevi,\u00a0primary melanomas and metastases was seen. PCNA (Proliferating Cell Nuclear\u00a0Antigen) can be considered another prognostic marker, it is a\u00a0polymerase and an antibody capable of marking it has been obtained. The\u00a0PCNA index is the number of labeled cells per 1000 tumor cells. In benign nevi the index averages 7.2 and in melanomas it is 248.5.<\/p>\n Regression:<\/strong>\u00a0it is the replacement of tumor tissue with fibrosis, degenerated cells\u00a0of melanoma, lymphatic proliferation and telangiectasias. There is often\u00a0a thinned epidermis with loss of the retiform pattern,\u00a0the dermis has fibroplasia with few inflammatory cells,\u00a0melanophages, edema and telangiectasias and the vessels are\u00a0perpendicular to the long axis of the epidermis. The results of the\u00a0studies are conflicting. Regression is present in 58% of melanomas. It seems that this element has no prognostic value in melanomas\u00a0deep, while in superficial melanomas regression can make\u00a0one think of a thicker tumor. A study confirmed that in the case of melanomas < 1 mm, regression was present in 42% of melanomas that metastasized and in 5% of melanomas that did not metastasize.<\/p>\n Lymphocytic infiltration:<\/strong> lymphocytic infiltration of the tumor mass is believed to be the\u00a0immune response to tumor cells, this response is measured by the\u00a0level of lymphocytic infiltrate at the base of the vertical growth\u00a0of the melanoma and is sometimes divided into: brisk, nonbrisk, absent. Some studies have shown that the greater the lymphocyte response, the better the prognosis. In cases in which a brisk lymphocytic\u00a0infiltrate (infiltrated within the entire tumor mass) is detected, the\u00a08-year survival is 77%, in cases of non-brisk lymphocytic\u00a0infiltrate (focal infiltrate) the survival is 53% and in cases in which the infiltrate is absent, survival drops to 37%. The presence\u00a0of macrophages and plasma cells is evaluated as a positive prognostic index<\/p>\n Angiolymphatic infiltration:<\/strong> some studies have shown a correlation between melanoma depth and angiolymphatic invasion, furthermore in cases of angiolymphatic invasion, metastases were more frequent with a reduction in survival. The presence of angiolymphatic invasion in a primary melanoma\u00a0in the vertical growth phase reduces survival by 40\u00a0% at 8 years. Often the presence of focal invasion makes it difficult to differentiate with respect to some artifacts for which immunohistochemistry against CD31 and CD34 endothelial targets can facilitate the differential diagnosis.<\/p>\n Microscopic satellitosis:<\/strong> nodules larger than 0.05 mm in width are considered separated by the vertical tumor growth. If 2 cm away from the tumor, they are\u00a0considered metastases in transit and are a sign of prognosis s<\/p>\n","protected":false},"excerpt":{"rendered":" Despite\u00a0the increased incidence of melanoma, the prognosis has improved markedly\u00a0in the last 20 years and this is due to an early diagnosis, in fact\u00a0more and more superficial melanomas are removed.<\/p>\n","protected":false},"author":13,"featured_media":0,"parent":5660,"menu_order":1,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-6237","page","type-page","status-publish","hentry"],"yoast_head":"\n