Melanoma Regression: A Quandary of Progression, Progress, and Prognosis

The British Journal of Dermatology recently described prognostic data regarding 1693 consecutive melanoma patients (American Joint Committee on Cancer stage I to II). Based on disease-free and overall survival and sentinel lymph node biopsy (SLNB) characteristics, the study found that the majority of regional lymph node metastases were in patients who did not undergo SLNB and that histologic regression was considered protective. The authors concluded that regression should not be an indication for SLNB in thin melanomas; in fact, it may be a favorable prognostic factor.

What’s the issue?

The art of medicine and its gray areas are respected and in full effect for melanoma, as clinicians always have to take into account the patient’s clinical history, comorbidities, and a fair amount of “gut instinct” in addition to the pathology specimen characteristics when deciding on surgical margins, imaging/laboratory tests, and particularly SLNB. How do you approach cases with regression? Although not an official upstaging factor anymore and now with evidence presented in the above study, how much do we worry and account for the mysterious route a particular melanoma took clinically and molecularly before the patient presented to us?

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