Clinical Presentation,Histology And Prognosis Of Primary Cutaneous Melanoma:A Study Of 368 Cases

Background Cutaneous malignant melanoma(CMM)is a high-grade malignant tumor derived from melanocytes,taking the third place in malignant skin tumors.In addition to cutaneous lesions,it also affects the mucosa,lymph nodes,and internal organs.In recent years,melanoma has being rapidly growing worldwide.In Asian patients,primary melanoma originated from skin account for approximately 50%-70%.Due to the low incidence of CMM,few foreign reports reviewed epidemiological data in Asian populations,and similar large-scale researches in China were relatively rare.Objective To analyze the clinical presentation,histology and outcome of patients with CMM in China.Methods we collected the patients from January 2010 to February 2018.Pathology and clinical follow-up data of the 368 patients with CMM in the Institute of Dermatology Chinese Academy of Medical Sciences were reviewed,and the clinical features,pathogenesis,clinical outcome were analyzed retrospectively.Results The average age of 368 patients with CMM was(61.01 ± 14.56)years.There were 165 males(44.84%)and 203 females(55.16%).There was no statistical significance of sexes.The most common primary site(79.89%)was the extremities,followed by the head and neck(8.42%),the limbs,and the trunk(4.35%).Thirty-four patients(9.24%)had a clear history of trauma before the occurrence of the disease.Microscopic ulcers were seen in 87 cases(23.64%).There were 238 cases(64.67%)of acral lentiginous melanoma(ALM),35(9.51%)of superficial spreading melanoma(SSM),28(7.61%)of Lentigo maligna melanoma(LMM),33(8.97%)of nodular melanoma(NM),others were rare or unclassifiable disease.The proportion of patients with clinical stage ?,?,?,and IV diseases were 24.23%,30.84%,33.04%,and 5.29%,respectively.The median follow-up time for the invasive group of patients was 44 months(range 2-102 months).Their follow-up data showed that 88 died from CMM metastasis,15 were withdrawn.The median survival time(MST)was 49.00 months(95%CI,39.78 to 58.20).The 1-,3-and 5-year survival rates were 87.4%,57.9%and 42%,respectively.Univariate analysis for overall survival(OS)showed that age,tumour ulceration,lymphatic metastasis,Breslow thickness,Clark classification,tumor mitotic rate,melanoma subtypes,clinical stage had a significantly poorer prognosis.Multivariate analysis demonstrated that advanced clinical staging was the most decisive prognostic factor followed by age,Breslow thickness,tumor mitotic rate,lymphatic metastasis,tumour ulceration.Conclusion The most common primary site was the extremities.The prognosis depends on clinical staging,age,Breslow thickness,tumor mitotic rate,lymphatic metastasis,tumour ulceration.