04 Malignant Skin Lesions

The presence of lymph node metastases is associated

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Unformatted text preview: ses at any site associated with elevated serum LDH 4 Malignant Skin Lesions — 6 tases), with or without in-transit or satellite lesions.The presence of lymph node metastases is associated with a substantially worse prognosis, with fewer than 50% of node-positive patients surviving for 5 years.34 The number of involved nodes is also a significant prognostic factor and is included as such in the current version of the AJCC melanoma staging system. Four prognostic factors have been identified that influence survival in patients with stage III melanoma: (1) the number of lymph nodes with metastases; (2) the presence of microscopic tumor deposits in lymph nodes, as opposed to macroscopic deposits; (3) the presence of in-transit or satellite metastases; and (4) the presence of ulceration in the primary lesion.34 At one time, the size of the involved lymph node was believed to be a significant prognostic factor, and it was included in earlier staging systems; currently, it is understood that this variable does not in fact exhibit a significant correlation with survival.37 However, macroscopic disease (i.e., disease that is identified clinically and confirmed histologically) does have a significant impact: the survival rate is much poorer in patients with macroscopic disease than in those with microscopic disease.34 In-transit and satellite metastases represent dissemination of tumor via lymphatic channels. The 5-year survival rates observed in patients with these findings are similar to those observed in patients with lymph node metastases. If in-transit or satellite metastases are present in association with lymph node metastases (N3), the survival rate is markedly reduced.34 Stage IV melanoma For stage IV melanoma, the most important prognostic factors appear to be (1) the site at which a distant metastasis occurs and (2) the serum LDH level. Within this group, patients with cutaneous metastases and normal serum LDH levels have by far the most favorable prognosis.There are significant differences in 1-year survival between patients who have cutaneous, subcutaneous, or distant nodal metastases (M1), those who have lung metastases (M2), and those who have any other visceral metastases or who have any metastases in association with an elevated serum LDH level (M3).The predicted 1-year survival rates for M1, M2, and M3 patients are 59%, 57%, and 41%, respectively.34 Table 4—American Joint Committee on Cancer Staging System for Melanoma LDH—lactic dehydrogenase Stage risk-stratification algorithm based on four factors: (1) mitotic rate (0% versus ≥ 1%), (2) growth pattern (radial or vertical), (3) gender, and (4) tumor-infiltrating lymphocyte (TIL) activity (brisk, nonbrisk, or absent).36 For minimal-risk and low-risk patients, the predicted risk for metastasis was less than 4%, whereas for moderaterisk and high-risk patients, the predicted risk for metastasis was 12% and 30%, respectively.36 Intermediate-thickness (1 to 4 mm) melanomas are c...
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This note was uploaded on 03/21/2011 for the course ONC 01 taught by Professor Dzodic during the Spring '11 term at Multimedia University, Cyberjaya.

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