What is the prognosis of lentigo maligna melanoma?

Updated: Dec 19, 2019
  • Author: Winston W Tan, MD, FACP; Chief Editor: William D James, MD  more...
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Answer

Melanoma is second only to adult leukemia in years of potential life lost in young adults. The disease is responsible for death in a disproportionately high number of young and middle-aged adults. [31] Lentigo maligna melanoma has a mortality rate similar to that of other melanoma types if depth of the tumor is taken into account. [32]

The overall prognosis is good for patients with localized melanoma and no nodal or distant metastases. An overall 5-year survival rate of 79% has been reported for patients with stage I or stage II lesions.

In patients with regional nodal disease (ie, stage III), the 3 dominant prognostic variables are the number of nodal metastases, the patient's age, and ulceration in the primary tumor (see Staging).

Numerous studies have shown that the number of nodes with metastases has significant prognostic value in patients with stage III disease. Patients with 1 positive node fared the best; 40% remained alive at 10 years. Those with 2-4 positive nodes had an intermediate 10-year survival rate of 26%. Patients with 5 or more positive nodes had the lowest 10-year survival rate, at 15%.

In both men and women with stage III melanoma, patients older than 50 years tend to do worse. In studies evaluating tumor ulceration as a prognostic factor in lentigo maligna melanoma, the 3-year survival rate for patients with an ulcerated primary tumor was 20%, compared with 35% for those with nonulcerated primary lesions.

Patients with stage IV melanoma generally have a poor prognosis. From the time the metastasis is diagnosed, the median survival is 6-7.5 months, with a 5-year survival rate of approximately 6%.

Patients with neck and scalp melanoma have shorter survival compared with melanoma at other sites (extremities, face, trunk). [33] In an analysis of the Surveillance, Epidemiology, and End Results (SEER) program data, patients with scalp and neck had a 1.84 risk of dying compared with patients affected at other sites such as extremity melanoma. The 5- and 10-year Kaplan Meier survival probabilities for scalp and neck melanoma were 83.1% and 76.2%, respectively, compared with melanoma of other sites at 92.1% and 88.7%, respectively. [33]


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