Absence of tumor infiltrating lymphocytes in primary biopsy and ulceration are associated with worse progression free survival in early stage cutaneous melanoma: a single center retrospective analysis

Background: Recent data suggest that a subset of early stage melanoma patients may benefit from adjuvant immunotherapy. Objective: To identify findings in biopsy or surgical pathology reports associated with poor prognosis in patients diagnosed with stage I and II cutaneous melanoma. Methods: This was a retrospective cohort study of 68 stage I and II cutaneous melanoma patients treated at our institution from 2010 to 2022. Inclusion criteria were patients with stage I or II melanoma with both a biopsy and surgical pathology report. The primary outcome of the study was the prognostic value of biopsy findings on progression free survival (PFS). Kaplan-Meier and Cox-proportional hazards models were used to evaluate risk factors for progression. Results: Patients with ulceration on biopsy had a 16.1x greater risk of progression than those without ulceration [HR 16.1, 95% CI: 2.60-99.5]. Patients with absent lymphocytes on biopsy had a 9.5x greater risk of progressing compared to those with lymphocytes present [HR 9.45, 95% CI: 1.99-44.8]. Ulceration or absent TILs were associated with significantly worse PFS. Conclusions: Ulceration and absence of TILs on biopsy are associated with increased risk of progression in stage I and II melanoma patients.