NEOPLASTIC PROGRESSION AND PROGNOSIS IN MELANOMA

Most melanomas evolve through an initial stage known as radial growth phase (RGP), encompassing in situ and microinvasive malignancies in wh ich the probability of cure approaches 100%. At the present time, desp ite a shift toward earlier recognition of melanoma, by the time of dia gnosis roughly 70% of melanomas have evolved to a point, known as vert ical growth phase (VGP) or tumorigenic melanoma, at which cure is not certain, and prognosis depends upon certain attributes of the neoplasm and the host. Attempts have been made to assemble these attributes in to prognostic models to permit estimation of the probability of cure f or individuals and for groups of patients. Attributes that have been i dentified as independent prognostic variables include thickness of the primary neoplasm, the numbers of mitotic figures, and the presence of tumor-infiltrating lymphocytes (TIL). Other biologically important pr ognostic variables are on the horizon, and some will likely be based o n molecules (markers) expressed on neoplastic cells that show function al significance in mechanisms of metastasis. Copyright (C) 1996 by W.B . Saunders Company.