A review of the Cleveland Clinic experience in malignant melanoma from the years 1969 to 1975 was undertaken to evaluate factors of significance in prognosticating the course of the disease. We classified melanomas of 145 patients according to clinical stage and histological presentation, using the levels of Clark and the micrometer thickness measurements of Breslow as criteria.
The worst prognostic factors were distant metastases and lymph node involvement, having a 70% mortality by the end of follow-up. The most important early prognostic indicator was the histology of the initial lesions. Patients with Clark's level I and II melanomas had a 70% survival, while patients with level IV and V melanomas had a 17% survival. Lesions less than 2 mm thick had a more favorable prognosis (63% survival), while thicker lesions had a 15% survival. Level III fell into two groups, with favorable lesions having thicknesses of less than 2
mm (70% survival), and lesions thicker than 2 mm carrying a poor prognosis (20% survival).
Another significant indicator was tumor site—truncal lesions having less favorable courses. Age, sex, and local recurrences were all found to have little significance.
Based on these findings, we present our approach to therapy.