CLINICAL PRESENTATION, NATURAL-HISTORY AND PROGNOSTIC FACTORS IN ADVANCED MALIGNANT-MELANOMA

Abstract

A retrospective study was made of the clinical findings and natural history of 140 patients with disseminated malignant melanoma treated over a 10 yr period. Multiple organ metastases were diagnosed clinically in 78% of all patients and seen at all autopsies. Routine roentgenograms of the chest did not diagnose metastases to the lung in 27% of the patients. The concomitant elevation of alkaline phosphatase, serum glutamic-oxalacetic transaminase and serum glutamic-pyruvic transaminase enyzmes is suggestive of underlying metastases to the liver even with a negative liver scan or normal liver size. Electroencephalography was sensitive in predicting and confirming metastases to the CNS prior to clinical manifestation with a 97% accuracy rate in clinically confirmed instances as compared with a 60% accuracy rate with brain scan. Age, sex and primary site of melanoma did not influence the survival once the disease became disseminated. Patients with a disease-free interval of more than 6 mo. statistically have a better chance of survival from the onset of systemic metastases, P = 0.001. Patients with a poor performance status of .gtoreq. 40% had a median survival period of 1 mo. as compared with 6 mo. with 90% performance, P + 0.001. Patients who initially presented with metastases to the skin or lymph nodes without other visceral involvement had a 14 mo. median survival rate as compared with 8 mo. in patients with metastases to the CNS only, 4 mo. with metastases to the liver and only 1 mo. in patients with multiple organ involvement, P = 0.0001.