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Nodular Melanoma in 62 Japanese Patients: Influence of Initial Surgical Treatment on Local Recurrence and Prognosis
Author(s) -
Kato Taizo,
Suetake Takaki,
Kumasaka Naka,
Tabata Nobuko,
Sugiyama Yasuko,
Tagami Hachiro
Publication year - 1995
Publication title -
the journal of dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.9
H-Index - 65
eISSN - 1346-8138
pISSN - 0385-2407
DOI - 10.1111/j.1346-8138.1995.tb03909.x
Subject(s) - medicine , acral lentiginous melanoma , nodular melanoma , melanoma , incidence (geometry) , superficial spreading melanoma , dermatology , stage (stratigraphy) , trunk , biopsy , lentigo maligna melanoma , head and neck , surgery , radiology , paleontology , ecology , physics , cancer research , optics , biology
The incidence of malignant melanoma is much lower in Japanese than in Caucasians, and the commonest type of melanoma in Japanese is acral lentiginous melanoma (ALM). In contrast to the improved prognosis noted in ALM, it is now of increasing concern that there is a rise in both the frequency and mortality of nodular melanoma. During the 25 years from 1970 to 1994, we observed 190 patients with melanoma, including 62 nodular melanomas and 96 ALM, at the Department of Dermatology, Tohoku University Hospital, Sendai, Japan. We retrospectively reviewed the recurrence and survival rates of nodular melanoma observed. The proportion of nodular melanoma, once comprising only 24% of all melanomas, showed a sharp increase to 40% after 1982. The anatomical sites of the primary tumor were the hands and feet (29%), extremities excluding hands and feet (27%), head and neck (23%), and trunk (21%). Comparison of the stages of nodular melanoma when diagnosed showed that the proportion of stage III remained highest throughout the whole period, but that of stage II melanomas increased after 1982. After treatment, local recurrence occurred far more frequently in nodular melanoma (19%) than in ALM (1%). The prognosis of nodular melanoma was also less favorable than that of ALM, although it slightly improved after 1982; the 5‐year survival rates before and after 1982 were 34 and 50%, respectively. Twenty‐eight patients with nodular melanoma had underwent simple excision or incisional biopsy of the primary tumor at another institution and were later referred to us for further intensive care or for the treatment of local recurrence and/or metastases. The rate of local recurrence of melanoma in such referred patients was higher than that in those who underwent an initial excision with wide margins in our hospital. Concurrently, the prognosis in the former group was significantly lower than that in the latter group; the 5‐year survival rate for the group of narrow initial margin was 22% in contrast to that of wide margin (56%). Combination therapy including initial surgical excision with wide margins as well as the careful follow‐up apparently result in a better outcome for the Japanese patients with nodular melanoma.