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Prognostic factors in melanoma

Stage III melanoma is disease that has spread regionally, or metastasized, to lymph nodes.¹ Patients with stage III disease have a high risk for disease recurrence after resection and poor survival rates.^1,2

In metastatic melanoma, the overall prognosis is poor.¹ Although less common, melanomas are considered more deadly than other non-melanoma skin cancers due to its ability to metastasise.³

Prognostic factors

Many factors can affect the prognosis of melanoma. Prognostic factors include BRAF and NRAS genetic mutations, tumour and disease characteristics, and patient factors (see figure).^4-8

Genetic mutations, such as BRAF and NRAS mutations, have been widely studied in relation to prognosis, with several studies supporting their role as a potential prognostic factor.^4,5,7,9 The next sections will discuss the relationship between BRAF mutation and other prognostic factors, including tumour and patient characteristics.

Prognostic factors in melanoma

Negative prognostic factors in metastatic disease include¹:

Increased lymph node involvement
Increased tumour burden
Anatomical site of disease (eg, brain, lung)
Increased serum lactate dehydrogenase (LDH) levels

In localised disease, the following characteristics are negative prognostic factors¹:

Increased tumour thickness
Elevated mitotic rate
Increased ulceration

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REFERENCES:

Gershenwald JE, et al; for members of the American Joint Committee on Cancer Melanoma Expert Panel and the International Melanoma Database and Discovery Platform. Melanoma staging: evidence-based changes in the American Joint Committee on Cancer eighth edition cancer staging manual. CA Cancer J Clin. 2017;67(6):472-92.
Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Cutaneous Melanoma. V.3.2019. © National Comprehensive Cancer Network, Inc. 2019. All rights reserved. Accessed March 21, 2019. To view the most recent and complete version of the guideline, go online to NCCN.org. NCCN makes no warranties of any kind whatsoever regarding their content, use or application and disclaims any responsibility for their application or use in any way.
National Cancer Institute. What you need to know about™ melanoma and other skin cancers. http://cancer101.org/wp-content/uploads/2012/08/C101_skin.pdf. Accessed August 28, 2019.
Hugdahl E, et al. BRAF-V600E expression in primary nodular melanoma is associated with aggressive tumour features and reduced survival. Br J Cancer. 2016;114(7):801-8.
Houben R, et al. Constitutive activation of the Ras-Raf signaling pathway in metastatic melanoma is associated with poor prognosis. J Carcinog. 2004;3(1):6.
National Cancer Institute. Cancer stat factss: melanoma of the skin. http://seer.cancer.gov/statfacts/html/melan.html. Accessed August 28, 2019.
Jang RW, et al. Simple prognostic model for patients with advanced cancer based on performance status. J Oncol Pract. 2014;10(5):e335-41.
Davies MA, et al. Prognostic factors for survival in melanoma patients with brain metastases. Cancer. 2011;117(8):1687-96.
Andrés-Lencina JJ, et al. TERT promoter mutation subtypes and survival in stage I and II melanoma patients. Int J Cancer. 2019;144(5):1027-36.

Disclaimer: This is an international website on the role of mutated BRAF in melanoma and BRAF testing and is intended for healthcare professionals outside the US. The information on this site is not country-specific and may contain information that is outside the approved indications in the country in which you are located.

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