Melanoma Prognosis — SCE Dermatology MCQ

Correct answer: D — Over 95% (>99% for T1a <0.8 mm without ulceration)

The correct answer is D, over 95% (with >99% quoted for the very lowest risk group, T1a, Breslow under 0.8 mm without ulceration). Thin melanoma without ulceration carries an excellent prognosis because Breslow thickness and ulceration status are the two dominant independent prognostic factors used in AJCC 8th edition staging, which underpins current UK staging as adopted by NICE NG14. A non-ulcerated melanoma of 1.0 mm technically falls into T1b (0.8 to 1.0 mm, or any thickness under 0.8 mm if ulcerated), rather than strict T1a, but it remains in the very low risk thin melanoma category with 10-year melanoma-specific survival still well above 95%. This is why NICE reserves sentinel lymph node biopsy discussion for thicker or higher-risk thin tumours rather than for straightforward T1a/T1b disease. Why the other options are wrong: A. 100% guaranteed: No malignancy, however thin, carries a guaranteed cure; a small proportion of even T1a melanomas recur or metastasise, so absolute certainty is never appropriate to quote to a patient. C. 30%: This figure reflects survival seen in advanced, metastatic (stage IV) melanoma, not early localised thin disease. B. 60%: This is closer to survival for higher stage, node positive (stage III) melanoma, far beyond the risk profile of a 1.0 mm non-ulcerated lesion. E. 80%: This underestimates thin melanoma outcomes; 80% approximates some stage II (thicker or ulcerated) tumour survival rather than T1 disease. Key point: Breslow thickness and ulceration status drive AJCC 8/NICE NG14 T-staging, and thin non-ulcerated melanoma has 10-year melanoma-specific survival consistently above 95%, never quoted as 100%.

Reference: NICE guideline NG14, Melanoma: assessment and management (updated 2022), staging based on AJCC 8th edition / UICC TNM 8, https://www.nice.org.uk/guidance/ng14