DOES PALPABILITY OF PRIMARY CUTANEOUS MELANOMA PREDICT DERMAL INVASION

Background: Relatively few studies have addressed the question of whet her clinical estimation of melanoma thickness by palpation can accurat ely predict its histologic thickness. if palpability was a reliable pr edictor of dermal invasion, it could be used to define the surgical ma rgin. Objective: We sought to determine whether clinical elevation of melanoma could be used to predict the presence or absence and the degr ee of dermal invasion in patients with stage 1 cutaneous melanoma. Met hods: Melanomas in 165 patients were categorized by one observer as fl at, just palpable, palpable, or nodular. This was compared with histol ogic measurements of tumor thickness. Results: Overall there was signi ficant correlation between the degree of palpability of melanoma and t he presence or absence of dermal invasion (p < 0.001), Breslow thickne ss (p < 0.0001), and Clark level (p < 0.001). However, the relation be tween palpability and Breslow thickness for invasive melanomas less th an 1 mm thick was weaker (n = 62, p = 0.053), and the correlation betw een elevation and Clark level was not significant for invasive melanom as less than 4 mm thick (n = 111, p > 0.999). Conclusion: We conclude that palpability of melanoma is an inadequate guide to the presence or absence and degree of dermal invasion in melanomas less than 1 mm thi ck and cannot be used to determine the surgical margin.