Prognosis

Prognosis is highly dependent on the stage at diagnosis. The most important prognostic indicators are Breslow depth of the tumor, ulceration, mitotic rate, and lymph node status.[14][63][95]​​​ An unfavorable prognosis is associated with histologic features of greater depth of invasion, ulceration, increased mitotic count, vascular invasion, regression, and the presence of microscopic satellites.[14] There is some evidence to suggest that patients with melanoma who are from ethnic minorities, especially black patients, experience worse health outcomes with regard to mortality.[186]

Five-year survival rates are:​[10]

  • Cancer localized to primary site (stage 0-II): 99.4%

  • Cancer metastasized to regional lymph nodes (stage III): 68%

  • Distant metastases (stage IV): 29.8%

Among patients with stage I and stage II disease, risk factors for metastasis are:[187]

  • Age older than 55 years

  • Acral or head/neck tumor

  • Breslow thickness >4 mm

  • Vascular invasion

  • Absence of regression

  • TERT promoter mutations

  • BRAF mutations

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