A 42-year-old woman has recently been diagnosed with cutaneous melanoma. She has no clinical evidence of metastatic disease, and her medical team is discussing her prognosis based on various pathological features of the tumor.
Which of the following variables best predicts prognosis for patients with a recent diagnosis of cutaneous melanoma and no clinical evidence of metastatic disease?
A. Breslow thickness
B. Clark’s level
C. Ulceration
D. Gender
Answer:
The Correct Answer is: A. Breslow thickness
Explanation:
Breslow thickness (A):
– Breslow thickness measures the depth of the melanoma in millimeters from the top of the granular layer of the epidermis to the deepest point of tumor invasion.
– It is the most important prognostic factor in cutaneous melanoma. The thicker the melanoma, the worse the prognosis, as thicker tumors have a higher likelihood of metastasizing.
– Breslow thickness is directly correlated with survival rates and is used to stage the melanoma and guide treatment decisions.
Explanation of Incorrect Options:
Clark’s level (B):
– Clark’s level describes the anatomic level of invasion of the melanoma in the skin (from level I in the epidermis to level V in the subcutaneous tissue).
– While it provides useful information, it is less predictive of prognosis compared to Breslow thickness, especially for tumors thicker than 1 mm.
Ulceration (C):
– Ulceration is an important prognostic factor and is associated with a worse prognosis in melanoma. However, it is not as strong a predictor as Breslow thickness.
– The presence of ulceration can affect staging and may indicate a more aggressive tumor.
Gender (D):
– Gender can have some influence on melanoma prognosis, with males generally having a worse prognosis than females. However, it is not as significant a predictor as Breslow thickness.
In conclusion, Breslow thickness is the variable that best predicts prognosis for patients with a recent diagnosis of cutaneous melanoma and no clinical evidence of metastatic disease, making option A the correct answer.