The pathology report returned three days later and confirmed that the tumor was a "Clark's Level
3 malignant melanoma with aggressive characteristics." This classification meant his cancer was rated a three on a scale of four for severity.
Accordingly, patients with melanoma greater than 1 mm in depth along with those between 0.76 mm and 1.0 mm in thickness had been considered for SLND if they had positive deep margins, lymphovascular invasion, age less than 40 years, significant vertical growth phase, increased mitotic rate, and Clark's level
IV or higher (5).
The extracted data from the eligible trials included first author's name, study type, trial location and year, sample size, age and gender of the patients, duration of follow-up, MVD assessment method, cut-off value for MVD, categorization of tumor based on Clark's level
and Breslow thickness, location and histotype of melanoma, and information regarding the treatment applied.
He referred her to a surgeon, who diagnosed malignant melanoma (Clark's level
V), with a satellite lesion but negative lymph nodes.
The other variables, Clark's level
, histological type, tumor location, ulceration and number of SLN harvested, were not significantly correlated with positive SLN status.
The pattern of worse outcomes in melanoma patients with a history of CLL was significant across all categories of Breslow tumor depth and Clark's level
, but it was most striking in patients with thicker lesions.
Histological examination with haemotoxylin and eosin staining was interpreted by the pathologist to be consistent with a 6 mm deep, Clark's level
"Nodular Malignant Melanoma, stage II, Clark's Level
IV, with some lymphatic infiltrate." At this point, his situation, with malignant cells in his lymph system, had become serious.
Differential diagnoses included a pigmented epithelioid melanocytoma, an agminated Spitz nevus, or a "low-grade" melanoma (Clark's level
III, Breslow thickness 3.7 mm).
He remained well with regard to the melanoma until 2005 when, at the age of 69, he had a second primary melanoma removed from his back, Breslow thickness 9mm, Clark's level
V, with no ulceration but areas of focal regression were seen.
Breslow's depth of invasion (measured in hundredths of a millimeter) and Clark's level
of invasion into the layers of the dermis (papillary dermis, reticular dermis, and subcutaneous layer) are both important components of the diagnosis, as they guide therapy and yield prognostic information.
* Tis: Melanoma in situ (including atypical melanocytic hyperplasia, severe melanocytic dysplasia); Clark's Level