Breslow's depth

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]


Overview

In medicine, Breslow's depth is used as a prognostic factor in melanoma of the skin. It is a description of how deeply tumor cells have invaded.

History

Depth of invasion was first reported as a prognostic factor in melanoma by the surgeon Dr. A. Breslow in 1970.[1] In recognition of his contribution, the depth of invasion of melanoma is referred to by the eponym Breslow's depth.

Subsequent studies confirmed and refined the role of depth of invasion in the prognosis of malignant melanoma.[2][3] Currently, Breslow's depth is included in the AJCC staging guidelines for melanoma as a major prognostic factor.

Measurement

Breslow's depth is most accurately measured by evaluating the entire tumor via an excisional biopsy. Determination from specimens obtained using other biopsy techniques, such as a wedge or punch biopsy, are less accurate. Breslow's depth cannot be calculated from a shave biopsy that only contains a portion of the tumor because it lead to an underestimation of its thickness.

Breslow's depth is determined by using an ocular micrometer at a right angle to the skin to directly measure the depth to which tumor cells have invaded the skin. Breslow's depth is measured from the granular layer of the epidermis down to the deepest point of invasion (sometimes involving detached nests of cells).

Prognostic importance

Breslow's depth is one of the cornerstones of the current AJCC TNM staging of malignant melanoma. A large study validated the importance of Breslow's depth as one of the three most important prognostic factors in melanoma (the others being T stage and ulceration).[4] Breslow's depth also accurately predicted the risk for lymph node metastasis, with deeper tumors being more likely to involve the nodes.[5]

The above studies showed that depth was a continuous variable correlating with prognosis. However, for staging purposes, the most recent AJCC guidelines use cutoffs of 1 mm, 2 mm, and 4 mm to divide patients into stages.

Breslow Thickness Approximate 5 year survival
<1mm 95-100%
1-2mm 80-96%
2.1-4mm 60-75%
>4mm 50%

Survival figures from British Association of Dermatologist Guidelines 2002

Clark's level

Clark's levels is a related staging system, often used in conjunction with Breslow's depth, which depends on multiple anatomical landmarks in the skin. In fact, Clark's level was the primary factor in earlier AJCC staging schemae for melanoma. However, with further study, it has been shown that Clark's level has a lower predictive value, is less reproducible, and is more operator-dependent as compared with Breslow's depth. Thus, in the current (2002) AJCC staging system, Clark's level has prognostic significance only in patients with very thin (Breslow depth <1 mm) melanomas.

References

  1. Thickness, cross-sectional areas and depth of invasion in the prognosis of cutaneous melanoma. Breslow A. Ann Surg 1970; 172:902.
  2. Primary cutaneous melanoma. Optimized cutoff points of tumor thickness and importance of Clark's level for prognostic classification. Buttner P; Garbe C; Bertz J; Burg G; d'Hoedt B; Drepper H; Guggenmoos-Holzmann I; Lechner W; Lippold A; Orfanos CE; et al. Cancer 1995 May 15;75(10):2499-2506.
  3. Critical analysis of the current American Joint Committee on Cancer staging system for cutaneous melanoma and proposal of a new staging system. Buzaid AC; Ross MI; Balch CM; Soong S; McCarthy WH; Tinoco L; Mansfield P; Lee JE; Bedikian A; Eton O; Plager C; Papadopoulos N; Legha SS; Benjamin RS. J Clin Oncol 1997 Mar;15(3):1039-51.
  4. Prognostic factors analysis of 17,600 melanoma patients: validation of the American Joint Committee on Cancer melanoma staging system. Balch CM; Soong SJ; Gershenwald JE; Thompson JF; Reintgen DS; Cascinelli N; Urist M; McMasters KM; Ross MI; Kirkwood JM; Atkins MB; Thompson JA; Coit DG; Byrd D; Desmond R; Zhang Y; Liu PY; Lyman GH; Morabito A. J Clin Oncol 2001 Aug 15;19(16):3622-34.
  5. Revised American Joint Committee on Cancer staging criteria accurately predict sentinel lymph node positivity in clinically node-negative melanoma patients. Rousseau DL Jr; Ross MI; Johnson MM; Prieto VG; Lee JE; Mansfield PF; Gershenwald JE. Ann Surg Oncol 2003 Jun;10(5):569-74.

See also

External links


nl:Breslow-dikte



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