Prognostic factors in malignant melanoma

Some of the most substantive recent developments regarding malignant melanoma involve the elucidation of prognostic factors in the disease. Formerly, melanoma had the well-justified reputation of being a capricious, unpredictable neoplasm. The advances in prognostic classification are largely due to pathological microstaging guidelines formulated by Clark et al. and Breslow [1, 2]. Their criteria have made it possible to precisely predict which patients have almost certainly been cured by wide local excision alone, which patients are likely to have occult distant metastases with a high risk for recurrence and which patients have occult metastasis confined to regional lymph nodes. Several of the long-standing issues in treating melanoma, such as the efficacy of prophylactic lymph node dissections and the role of various modalities of adjuvant therapy, should be readily resolvable with well-designed studies involving a practical number of subjects now that it is possible to form subgroups of patients with uniform prognostic features.