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<p>Brain metastasis (BM) is a feared complication of melanoma and is strongly associated with the presence of ulceration. However, most cases of melanoma are non-ulcerated. The varying presentation of ulcerated and non-ulcerated melanoma with BM at diagnosis may highlight potential underlying biological differences. Patients with BM at the time of melanoma diagnosis were gathered from the Surveillance, Epidemiology, and End Results (SEER) database. Logistic regression identified which variables were more likely to be present in the non-ulcerated group. Cox regressions identified important prognostic variables. This study included 672 patients, 413 of whom had non-ulcerated melanoma. Those without ulceration were more likely to have a mitotic rate &lt; 1 (OR = 0.23 [95% CI 0.06, 0.71], <i>p</i> = 0.015) and to have a lower T-stage. After adjusting for covariates, ulceration was associated with increased mortality (HR = 1.47 [95% CI 1.18, 1.84], <i>p</i> = 0.0007). Primary site surgery increased survival in non-ulcerated melanoma (HR = 0.70 [95% CI 0.51, 0.97], <i>p</i> = 0.030) but not in ulcerated melanoma (HR = 1.02 [95% CI 0.70, 1.50], <i>p</i> = 0.91). Similarly, distant-site surgery increased survival in non-ulcerated melanoma (HR = 0.50, [95% CI 0.39, 0.65], <i>p</i> &lt; 0.0001) but not in ulcerated melanoma (HR = 0.70, [95% CI 0.46, 1.07], <i>p</i> = 0.097). These findings demonstrate differences between ulcerated and non-ulcerated melanoma that resulted in BM. Variables indicating the aggressiveness of the primary tumor, such as T-stage, likely play a greater role in developing BM in the ulcerated group. The findings of this study suggest that aggressive forms of non-ulcerated and ulcerated melanoma may have a distinct pathophysiology that requires further study.</p>

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Ulcerated versus non-ulcerated melanoma with brain metastasis at diagnosis: a retrospective analysis of clinical differences and prognosis

  • 期刊论文

  • 发表日期：

    2026年7月22日

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  • Eli Berglas,
  • Kevin Wang,
  • Rachel Berglas,
  • Nicholas Stratigakis,
  • Alexander Pan,
  • Netanel Yomtov,
  • Caroline Halverstam

摘要

Brain metastasis (BM) is a feared complication of melanoma and is strongly associated with the presence of ulceration. However, most cases of melanoma are non-ulcerated. The varying presentation of ulcerated and non-ulcerated melanoma with BM at diagnosis may highlight potential underlying biological differences. Patients with BM at the time of melanoma diagnosis were gathered from the Surveillance, Epidemiology, and End Results (SEER) database. Logistic regression identified which variables were more likely to be present in the non-ulcerated group. Cox regressions identified important prognostic variables. This study included 672 patients, 413 of whom had non-ulcerated melanoma. Those without ulceration were more likely to have a mitotic rate < 1 (OR = 0.23 [95% CI 0.06, 0.71], p = 0.015) and to have a lower T-stage. After adjusting for covariates, ulceration was associated with increased mortality (HR = 1.47 [95% CI 1.18, 1.84], p = 0.0007). Primary site surgery increased survival in non-ulcerated melanoma (HR = 0.70 [95% CI 0.51, 0.97], p = 0.030) but not in ulcerated melanoma (HR = 1.02 [95% CI 0.70, 1.50], p = 0.91). Similarly, distant-site surgery increased survival in non-ulcerated melanoma (HR = 0.50, [95% CI 0.39, 0.65], p < 0.0001) but not in ulcerated melanoma (HR = 0.70, [95% CI 0.46, 1.07], p = 0.097). These findings demonstrate differences between ulcerated and non-ulcerated melanoma that resulted in BM. Variables indicating the aggressiveness of the primary tumor, such as T-stage, likely play a greater role in developing BM in the ulcerated group. The findings of this study suggest that aggressive forms of non-ulcerated and ulcerated melanoma may have a distinct pathophysiology that requires further study.