The objective of this study was to review our experience with thick cu
taneous melanoma of the trunk and extremities and to identify subgroup
s of long-term survivors. Ninety-one patients admitted between the yea
rs 1977 and 1987, with cutaneous melanoma of the trunk or extremities,
Breslow thickness greater than or equal to 4.0 mm, or a Clark's level
V lesion form the basis of this review. Node positive clinical stage
II patients had a 5-year survival rate of 32%. Five-year survival for
node positive clinical stage III patients was 0% (P < 0.0001). Node ne
gative clinical stage II patients, and those found to be histologicall
y node positive, had no survival difference, P = 0.88. Sixty per cent
of node negative patients with an extremity primary survived 5 years,
while patients with a node positive truncal primary had a survival of
14%, P = 0.005. in conclusion, most patients present with local-region
al disease. Patients with node negative extremity lesions have the bes
t chance for cure.