Moreover, any diagnostic report should be also accompanied by further well-known microstaging attributes, such as Clark level
, mitotic count, lymphovascular invasion, perineural infiltration, ulceration, satellitosis, tumor infiltrating lymphocytes, and, if available, sentinel lymph node status (10, 11).
One of the three patients with a negative SLNB and positive PET/CT finding was a 47-year-old female patient with superficial spreading melanoma localized in the abdomen, the tumor being Clark level
III with a thickness of 0.6 mm without ulceration.
Among the proposed indicators were both clinical parameters and tumor characteristics, such as age, sex, Breslow index, ulceration, anatomic site, Clark level
, mitotic rate, histological regression, and vascularity [6,7].
of invasion was an important predictor only for the group of patients with thin melanomas measuring 1 mm or less.
The melanoma had a Breslow thickness of 1.8mm and he had Clark level
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.
In 26 cases the Clark level
could not be evaluated on the available material and in 19 cases the Breslow thickness could not be measured.
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).
Breslow thickness Essential Surgical margin/tissue edge status Essential Ulceration Essential Mitotic count Essential Satellites Essential Lymphovascular invasion Essential Desmoplastic melanoma component Essential Neurotropism Essential Extent of ulceration Recommended Clark level
Recommended Tumour-infiltrating lymphocytes Recommended Tumour regression Recommended Tumour regression margins Recommended Associated melanocytic lesion Recommended Intraepidermal melanoma growth pattern Recommended Melanoma subtype Recommended
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.