Model predicting survival in stage I melanoma based on tumor progression

Wallace H. Clark, David E. Elder, Dupont Guerry, Leonard E. Braitman, Bruce J. Trock, Delray Schultz, Marie Synnestvedt, Allan C. Halpern

Research output: Contribution to journalArticlepeer-review

924 Scopus citations


We used the lesional steps in tumor progression and multi-variable logistic regression to develop a prognostic model for primary, clinical stage I cutaneous melanoma. This model is 89% accurate in predicting survival. Using histologic criteria, we assigned melanomas to tumor progression steps by ascertaining their particular growth phase. These phases were the in situ and invasive radial growth phase and the vertical growth phase (the focal formation of a dermal tumor nodule or dermal tumor plaque within the radial growth phase or such dermal growth without an evident radial growth phase). After a minimum follow-up of 100.6 months and a median follow-up of 150.2 months, 122 invasive radial-growth-phase tumors were found to be without metastases. Eight-year survival among the 264 patients whose tumors had entered the vertical growth phase was 71.2%. Survival prediction in these patients was enhanced by the use of a multivariable logistic regression model. Twenty-three attributes were tested for entry into this model. Six had independently predictive prognostic information: (a) mitotic rate per square millimeter, (b) tumor-infiltrating lymphocytes, (c) tumor thickness, (d) anatomic site of primary melanoma, (e) sex of the patient, and (f) histologic regression. When mitotic rate per square millimeter, tumor-infiltrating lymphocytes, primary site, sex, and histologic regression are added to a logistic regression model containing tumor thickness alone, they are independent predictors of 8-year survival (P <.0005). [J Natl Cancer Inst 81: 1893-1904, 1989]

Original languageEnglish (US)
Pages (from-to)1893-1904
Number of pages12
JournalJournal of the National Cancer Institute
Issue number24
StatePublished - Dec 20 1989
Externally publishedYes

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


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