溃疡是皮肤黑色素瘤的一个关键特征，有助于根据当前的美国癌症联合委员会 (AJCC) 系统进行分期。然而，早期溃疡的病例并不完全符合 AJCC 对溃疡的定义，因此被归类为非溃疡，这给病理学家带来了解释上的困难。早期溃疡的预后意义尚不确定。旨在评估皮肤黑色素瘤早期溃疡的预后意义。这项病例对照研究包括 2005 年至 2015 年间诊断的切除的原发性皮肤黑色素瘤，从澳大利亚黑色素瘤研究所研究数据库中确定，并提供可用的幻灯片以便在皇家阿尔弗雷德王子医院进行审查。由具有诊断黑素细胞病变经验的病理学家对载玻片进行审查，以确定病例（早期溃疡）和对照（溃疡或非溃疡）。初期溃疡病例分别以 1:2 的比例与未溃疡和溃疡对照进行匹配。研究分析于2023年3月至6月进行。比较病例和对照之间的临床病理因素和临床结果：总生存期（OS）、黑色素瘤特异性生存期（MSS）和无复发生存期（RFS）。2284名黑色素瘤患者经鉴定，340 名患者（中位 [IQR] 年龄，69 [24-94] 岁；136 名 [68%] 男性；中位随访时间，7.2 年）符合标准。匹配队列由 40 例早期溃疡性黑色素瘤病例组成，与 80 例非溃疡性对照和 80 例溃疡性对照进行 1:2 匹配。病例和对照之间的 Breslow 厚度中位数 (IQR) 存在显着差异；初期病例为 2.8 (1.7-4.1) mm，而非溃疡性黑色素瘤和溃疡性黑色素瘤分别为 1.0 (0.6-2.1) mm 和 5.3 (3.5-8.0) mm。早期溃疡病例中肿瘤有丝分裂率为 5.0 (3.0-9.0)/mm2，相比之下，非溃疡对照为 1 (0-3.0)/mm2，溃疡对照为 9 (5.0-14.0)/mm2。根据匹配队列，非溃疡性肿瘤患者的 OS（风险比 [HR]，0.49；95% CI，0.27-0.88；P = .02）和 RFS（HR，0.37；95% CI，0.22-0.64）明显更好; P < .001) 高于早期溃疡患者。与早期溃疡病例相比，溃疡性肿瘤的 RFS 明显较差（HR，1.67；95% CI，1.07-2.60；P = .03）。调整病理因素后，病例组和对照组之间的临床结果没有观察到统计学上的显着差异。这项病例对照研究的结果表明，原发性黑色素瘤的早期溃疡代表了一种不良预后特征，病理学家应注意这一点他们的报告并在未来的指导方针中得到考虑。

Ulceration represents a key feature in cutaneous melanoma, contributing to staging according to the current American Joint Committee on Cancer (AJCC) system. However, cases with incipient ulceration do not quite fulfill the AJCC definition of ulceration and are consequently classified as nonulcerated, presenting interpretive difficulty for pathologists. The prognostic implication of incipient ulceration is uncertain.To evaluate the prognostic significance of incipient ulceration in cutaneous melanoma.This case-control study consisted of resected primary cutaneous melanomas diagnosed between 2005 and 2015, identified from the Melanoma Institute Australia research database and with slides available for review at Royal Prince Alfred Hospital. Slides were reviewed by pathologists experienced in the diagnosis of melanocytic lesions to identify cases (incipient ulceration) and controls (ulcerated or nonulcerated). Incipient ulceration cases were matched at a 1:2 ratio with nonulcerated and ulcerated controls, respectively. Study analysis was conducted from March to June 2023.Clinicopathological factors and clinical outcomes: overall survival (OS), melanoma-specific survival (MSS), and recurrence-free survival (RFS) were compared between cases and controls.Of 2284 patients with melanoma identified, 340 patients (median [IQR] age, 69 [24-94] years; 136 [68%] men; median follow-up, 7.2 years) met the criteria. The matched cohort consisted of 40 cases of incipiently ulcerated melanoma matched 1:2 with 80 nonulcerated controls, and 80 ulcerated controls. The median (IQR) Breslow thickness differed significantly between cases and controls; 2.8 (1.7-4.1) mm for incipient cases compared with 1.0 (0.6-2.1) mm and 5.3 (3.5-8.0) mm for nonulcerated and ulcerated melanomas, respectively. Median (IQR) tumor mitotic rate was 5.0 (3.0-9.0) per mm2 in incipiently ulcerated cases compared with 1 (0-3.0) per mm2 in nonulcerated controls and 9 (5.0-14.0) per mm2 in ulcerated controls. Based on the matched cohorts, patients with nonulcerated tumors had significantly better OS (hazard ratio [HR], 0.49; 95% CI, 0.27-0.88; P = .02) and RFS (HR, 0.37; 95% CI, 0.22-0.64; P < .001) than patients with incipient ulceration. The RFS was significantly worse in ulcerated tumors compared with incipiently ulcerated cases (HR, 1.67; 95% CI, 1.07-2.60; P = .03). After adjusting for pathological factors, no statistically significant differences in clinical outcomes were observed between cases and either control group.The findings of this case-control study indicate that incipient ulceration in a primary melanoma represents an adverse prognostic feature that should be noted by pathologists in their reports and considered in future guidelines.