of invasion was an important predictor only for the group of patients with thin melanomas measuring 1 mm or less.
Kent, the most significant change from the 2001 guidelines relates to staging, with mitotic rate replacing Clark level
of invasion as the second factor predicting melanoma survival in addition to tumor (Breslow) thickness for tumors 1 mm or smaller in thickness.
Moreover, in melanomas with polypoid growth pattern, the tumor can reach a thick Breslow thickness but still be a Clark level
None of the cases was found to be Clark level
I or II.
We performed a rhomboid flap reconstruction of a 2-cm left cheek defect in a 58-year-old man who had previously undergone wide local excision and sentinel lymph node mapping for a Clark level
III melanoma (figure 3, A).
Histopathology reports were reviewed for patients' geographical area, gender, age, ethnic group, tumour site, Clark level
of invasion, Breslow thickness (mm), and histogenetic type (when available).
The survival of patients with melanomas of Clark level
II was much better than that for patients with tumors at deeper levels (3,4); although the tumor had metastasized for 3 of 36 patients with level II melanomas in the initial study, subsequent studies showed a much superior survival rate of approximately 98% when polypoid melanomas are excluded.
Specifically, 37% of all tumors (but 71% of those that recurred) had a lesional depth exceeding 4 mm, and 33% of all tumors (but 71% of those that recurred) were Clark level
V "Perineural invasion was actually seen in quite a few of the tumors [15%], probably more so than conventional SCC," Dr.
Anatomic level has been replaced by mitotic rate in the AJCC 7th edition tables for subclassifying pT1 lesions as T1a or T1b, but in the text and in a table comment of the AJCC chapter, (10) Clark level
IV or V is referred to as a tertiary criterion for T1b in cases with no ulceration and "if mitotic rate cannot be determined.
High osteopontin expression was also associated with greater Clark level
, tumor thickness, and mitotic index, which are among the key factors in the American Joint Committee on Cancer staging criteria.
In a univariate analysis, Clark level
, lymphovascular invasion, vertical growth, biopsy type, and location of the primary rumor on the head, neck, or trunk were not predictive of SLN metastasis.