Epidemiological and histopathological profile of cutaneous melanoma at a center in northeastern Brazil from 2000 to 2010

Vilanova, Camila Maria Arruda; Lages, Rafael Bandeira; Ribeiro, Sahâmia Martins; Almeida, Isabella Parente; Santos, Lina Gomes dos; Vieira, Sabas Carlos

doi:10.1590/abd1806-4841.20132036

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Investigation • An. bras. dermatol. 88 (4) • Aug 2013 • https://doi.org/10.1590/abd1806-4841.20132036 copy

Epidemiological and histopathological profile of cutaneous melanoma at a center in northeastern Brazil from 2000 to 2010^* * Study conducted at the São Marcos Hospital and Federal University of Piauí (UFPI) - Teresina (PI), Brazil.

Perfil epidemiológico e histopatológico do melanoma cutâneo em um centro do nordeste brasileiro de 2000 a 2010

Authorship SCIMAGO INSTITUTIONS RANKINGS

BACKGROUND:

While representing only 3-4% of malignant skin tumors, cutaneous melanoma is the most aggressive and lethal. Statistical knowledge about the biological behavior of this tumor is essential for guiding daily outpatient practice and aiding public health policies.

OBJECTIVES:

To analyze the profile of patients with cutaneous melanoma attending a pathology department in Teresina (state of Piauí) between 2000 and 2010.

METHODS:

Retrospective study of melanoma patients diagnosed between 2000 and 2010 in the São Marcos Hospital in the city of Teresina. The pathology laboratory reports were studied and all the statistical analyses performed using SPSS 19.0.

RESULTS:

A total of 25 in situ, 199 invasive and 89 metastatic melanomas of unknown primary site were observed. Histological types found were nodular (52.8%), superficial spreading melanoma (18.6%), acral (10.6%) and lentigo maligna (9.5%). In 144 (73.4%) cases the Breslow thickness was >1 mm. Metastasis was found in 28.6% of invasive melanomas and nodular melanoma, Clark IV/ V, Breslow > 1 mm, mitotic index > 6 and ulcerated lesions were more likely to metastasize.

CONCLUSION:

Most melanomas presented Breslow> 1mm. The main factors associated with metastasis were nodular type, Clark IV / V, Breslow> 1mm, mitotic index > 6 and ulcerated lesions.

Epidemiology; Melanoma; Neoplasm metastasis; Neoplasms, unknown primary; Skin neoplasms

	Gender
Category	Male		Female		Total		p^ Pearson chi-square test or Fisher’s exact test

	n	%	n	%	n	%
Total	97	48.7	101	50.8	*199^ * One patient with missing gender data**	100.0

Age Group (years)							0.400
≤ 50	12	12.4	10	9.9	22	11.1
> 50	82	84.5	85	84.2	167	83.9
Missing	3	3.1	6	5.9	10	5.0
Origin							0.381
Teresina	28	28.9	31	30.7	59	29.6
Rural area of Piauí	42	43.3	37	36.6	79	39.7
Other state	23	23.7	33	32.7	56	28.1
Missing	4	4.1	0	0.0	5	2.5
Site							0.038
Head and neck	14	14.4	26	25.7	40	20.1
Trunk	33	34.0	29	28.7	62	31.2
Upper Limbs	7	7.2	15	14.9	22	11.1
Lower Limbs	39	40.2	28	27.7	67	33.7
Missing	4	4.1	3	2.9	8	4.0
Histological Type							0.678
Nodular	55	56.7	50	49.5	105	52.8
Lentigo maligna	10	10.3	9	8.9	19	9.5
Superficial spreading	15	15.5	22	21.8	37	18.6
Acral lentiginous	10	10.3	11	10.9	21	10.6
Other	3	3.1	2	2.0	5	2.5
Missing	4	4.1	7	6.9	12	6.0
Breslow							0.045
≤ 1 mm	14	14.4	25	24.8	39	19.6
> 1 mm	76	78.4	68	67.3	144	72.4
Missing	7	7.2	8	7.9	16	8.0
Clark Level							0.461
II 11	11.3	20	19.8	31	15.6
III	18	18.6	16	15.8	34	17.1
IV	35	36.1	30	29.7	65	32.7
V26	26.8	26	25.7	52	26.1
Missing	7	7.2	9	8.9	17	8.5
Tumor-infiltrating lymphocytes							0.299
Absence	17	17.5	14	13.9	31	15.6
Presence	73	75.3	80	79.2	153	76.9
Missing	7	7.2	7	6.9	15	7.5
Mitotic index							0.011
< 6 mitoses/HPF	44	45.4	60	59.4	104	52.3
≥ 6 mitoses/HPF	45	46.4	29	28.7	74	37.2
Missing	8	8.2	12	11.9	21	10.6
Ulceration							0.147
Absence	32	33.0	42	41.6	74	37.2
Presence	57	58.8	52	51.5
Missing	8	8.2	7	6.9	16	8.0
Histopathological regression							0.060
Absence	66	68.0	80	79.2	146	73.4
Presence	21	21.6	13	12.9	34	17.1
Missing	10	10.3	8	7.9	19	9.5

	Metastasis
Category	Presence		Absence		*OR^ * Odds Ratio**	95 CI^ 95% Confidence Interval
	n	%	n	%
Total	57	28.6	142	71.4
Gender
Female	27	26.7	74	73.3	1.00
Male	30	30.9	67	69.1	1.23	0.66-2.27
Age Group (years)
≤ 50	5	22.7	17	77.3	1.00
> 50	50	29.9	117	70.1	1.45	0.51-4.16
Site
Head and neck	12	30.0	28	70.0	1.99	0.78-5.08
Trunk	11	17.7	51	82.3	1.00
Upper Limbs	7	31.8	15	68.2	2.16	0.71-6.56
Lower Limbs	26	38.8	41	61.2	2.94	1.30-6.65
Histological Type
Nodular	39	37.1	66	62.9	4.88	1.61-14.8
Lentigo maligna	2	10.5	17	89.5	0.97	0.16-5.85
Superficial spreading	4	10.8	33	89.2	1.00
Acral lentiginous	6	28.6	15	71.4	3.30	0.81-13.45
Breslow
≤ 1 mm	2	5.1	37	94.9	1.00
> 1 mm	54	37.5	90	62.5	11.1	2.57-47.91
Clark Level
II		4	12.9	27	87.1	1.00
III	3	8.8	31	91.2	0.65	0.13-3.18
IV	25	37.9	41	62.1	4.12	1.29-13.15
V	24	46.2	28	53.8	5.79	1.77-18.89
Tumor-infiltrating lymphocytes
Absence	13	41.9	18	58.1	1.00
Presence	43	27.9	111	72.1	0.54	0.24-1.19
Mitotic index
< 6 mitoses/HPF	22	20.9	83	79.1	1.00
≥ 6 mitoses/HPF	30	40.5	44	59.5	2.57	1.33-4.98
Ulceration
Absence	15	20.0	60	80.0	1.00
Presence	41	37.6	68	62.4	2.41	1.21-4.79
Histopathological regression
Absence	45	30.6	102	69.4	1.06	0.47-2.39
Presence	10	29.4	24	70.6	1.00

Metastatic site	n	%
Lymph node	114	78.1
Skin and subcutaneous	33	22.6
Lung	10	6.8
Liver	7	4.8
Brain	4	2.7
Bowel	2	1.4
Bone	2	1.4
Adrenal	1	0.7
Parotid	1	0.7
Salivary gland	1	0.7
Cerebellum	1	0.7

City	Author	n	Years	Histological type		Clark level		Breslow	In situ
City	Author	n	Years	SS	NO	IV	V	≤ 1mm
São Paulo-SP	Criado et al.⁷7. Criado PR, Vasconcellos C, Sittart JAS, Valente NYS, Moura BPS, Barbosa GL, et al. Melanoma malign cutâneo primário: estudo retrospectivo de 1963 a 1997 no Hospital do Servidor Público Estadual de São Paulo. Rev Ass Med Bras. 1999;45:157-62.	222	1963-1997	-	-	39.8%	10.2%	28.4%^* * ≤ 0.75mm	9.7%
Blumenau-SC	Naser⁸8. Nasser N. Cutaneous melanoma - a 30-year-long epidemiological study conducted in a city in southern Brazil from 1980-2009. An Bras Dermatol. 2011;86:932-41.	1002	1980-2009	51.6%	37.0%	23.2%	22.8%	58.7%	10.5%
São Paulo-SP	Lapa et al.⁹9. Lapa MS, Guedes KF, Schalch FO, Landman G. Cutaneous malignant melanomas treated at the Hospital do Cancer in São Paulo: Retrospective study for the evaluation of distribution, prognostic factors and survival. An Bras Dermatol. 2002;77:313-20.	115	1985-1987	-	19.8%	-	-	9.6%^* * ≤ 0.75mm	-
Porto Alegre-RS	Venegas et al.¹⁰10. Venegas LFP, Flores C, Blacher GG, Daudt AW, Cerski CTS. Melanoma maligno cutâneo no Rio Grande do Sul: estudo de 101 casos. Rev Ass Med Brasil. 1992;38:122-6.	101	1985-1989	-	36.6%	-	35.6%	-	-
Londrina-PR	Gon et al.¹¹11. Gon AS, Minelli L, Guembarovski AL. Primary cutaneous melanoma in Londrina. An Bras Dermatol. 2001;76:413-26.	303	1990-1999	37.1%	41.1%	23.1%	34.8%	13.4%^* * ≤ 0.75mm	12.9%
Porto Alegre-RS	Bakos¹²12. Bakos L. Melanomas malignos e etnia. An Bras Dermatol. 1991;66:299-302.	153	-	51.6%	-	-	-	-	-
Rio de Janeiro-RJ	Fernandes et al.¹³13. Fernandes NC, Calmon R, Maceira JP, Cuzzi T, Silva CSC. Cutaneous melanoma: prospective study of 65 cases. An Bras Dermatol. 2005;80:25-34.	65	1993-2003	63.0%	12.3%	-	-	-	-
São Paulo-SP	Ferrari Júnior et al.³3. Ferrari Júnior NM, Muller H, Ribeiro M, Maia M, Sanches Júnior JA. Cutaneous melanoma: descriptive epidemiological study. São Paulo Med J. 2008;126:41-7.	364	1993-2006	33.8%	26.1%	25.4%	20.4%	23.9%	15.7%
Brasília-DF	Pinheiro et al.¹⁴14. Pinheiro AMC, Friedman H, Cabral ALSV, Rodrigues HA. Cutaneous melanoma: clinical, epidemiological and histopathological characteristics at the University Hospital of Brasília between January 1994 and April 1999. An Bras Dermatol. 2003;78:179-86.	32	1994-1999	10.0%	45.0%	19.4%	32.3%	42.3%^* * ≤ 0.75mm	12.9%
Porto Alegre-RS	Bakos et al.¹⁵15. Bakos L, Wagner M, Bakos RM, Leite CS, Sperhacke CL, Dzekaniak KS, et al. Sunburn, sunscreens and phenotypes: some risk factors for cutaneous melanoma in southern Brazil. Int J Dermatol. 2002;41:557-62.	103	1995-1998	61.2%	23.3%	-	-	-	-
Passo Fundo-RS	Borges et al.¹⁶16. Borges SZ, Bakos L, Cartell A, Wagner M, Agostini A, Lersch E. Distribution of clinicalpathological types of cutaneous melanomas and mortality rate in the region of Passo Fundo, RS, Brazil. Int J Dermatol. 2007;46:679-86.	229	1995-2001	61.6%	25.3%	24.4%	7.9%	47.2%	7.9%
Porto Alegre-RS	Ponzio et al.¹⁷17. Ponzio HA. Frequência de melanoma maligno no Serviço de Dermatologia da I SCMPA/UFRGS. An Bras Dermatol. 1998;73:S6-11.	167	-	35.3%	-	-	-	-	-
Florianópolis-SC	Weber et al.¹1. Weber AL, Nunes DH, Souza Filho JJ, Pinto CJC. Assessment of 496 pathological reports of melanoma diagnosed in the city of Florianopolis, SC, Brazil. An Bras Dermatol. 2007;82:227-32.	496	1999-2004	60.0%	30.0%	-	-	45.7%	37.5%
Porto Alegre-RS	Bonfá et al.⁴4. Bonfá R, Bonfá R, Furian RD, Bonamigo RR, Duro KM, Zelmanowicz AM. Early diagnosis of cutaneous melanoma: an observation in southern Brazil. An Bras Dermatol. 2011;86:215-21.	328	2000-2005	62.8%	14.6%	27.4%	7.0%	36.9%	26.2%
São Paulo-SP	Maia et al.¹⁸18. Maia M, Russo C, Ferrari N, Ribeiro MCS de A, Santos ABOS. Reflections regarding The epidemiology of cutaneous melanoma in Brazil. An Bras Dermatol. 2002;77:163-70.	190	-	41.1%	-	-	-	-	-
Florianópolis-SC	Dimatos et al.⁵5. Dimatos DC, Duarte FO, Machado RS, Vieira VJ, Vasconcellos ZAA, Bins-Ely J, et al. Melanoma cutâneo Brasil. Arq Cat Med. 2009;38(Supl. 1):14-9.	105	2003-2007	68.7%	18.2%	19.0%	5.7%	30.4%	39.0%
Criciúma-SC	Konrad el al.¹⁹19. Konrad P, Fabris MR, Melao S, Blanco LFO. Histopathological and epidemiological profile of cases of primary cutaneous melanoma diagnosed in Criciúma-SC between 2005 and 2007. An Bras Dermatol. 2011;86:457-61.	72	2005-2007	50.0%	23.4%	26.1%	0.0%	25.0%^* * ≤ 0.75mm	29.6%
Teresina-PI	This study	313	2000-2010	18.6%	52.8%	32.7%	26.1%	19.6%	7.9%

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Epidemiological and histopathological profile of cutaneous melanoma at a center in northeastern Brazil from 2000 to 2010* * Study conducted at the São Marcos Hospital and Federal University of Piauí (UFPI) - Teresina (PI), Brazil.

Perfil epidemiológico e histopatológico do melanoma cutâneo em um centro do nordeste brasileiro de 2000 a 2010

BACKGROUND:

OBJECTIVES:

METHODS:

RESULTS:

CONCLUSION:

Epidemiological and histopathological profile of cutaneous melanoma at a center in northeastern Brazil from 2000 to 2010^* * Study conducted at the São Marcos Hospital and Federal University of Piauí (UFPI) - Teresina (PI), Brazil.