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Breslow's depth

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Title: Breslow's depth  
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Subject: Melanoma, Cancer staging, Histopathology
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Breslow's depth

In medicine, Breslow's depth was used as a prognostic factor in melanoma of the skin. It is a description of how deeply tumor cells have invaded. Currently, the standard Breslow's depth has been replaced by the AJCC depth. Originally, Breslow's depth was divided into 5 stages.[1]


  • Classification 1
  • History 2
  • Measurement 3
  • Prognostic importance 4
  • Clark's level 5
  • References 6
  • See also 7
  • External links 8


Breslow's depth
Stage Depth
Stage I less or equal to 0.75mm
Stage II 0.76 mm - 1.50mm
Stage III 1.51 mm - 2.25mm
Stage IV 2.26 mm - 3.0mm
Stage V greater than 3.0 mm[1]


Depth of invasion was first reported as a prognostic factor in melanoma by the

  • Breslow Thickness and Ulceration Predict Survival. Article demonstrating how Breslow Thickness relates to prognosis and survival time in melanoma.
  • Melanoma Staging Systems. National Cancer Institute. A resource on Clark's levels and Breslow's depth.

External links

See also

  1. ^ a b c Breslow, Alexander (1970). "Thickness, Cross-Sectional Areas and Depth of Invasion in the Prognosis of Cutaneous Melanoma". Annals of Surgery 172 (5): 902–8.  
  2. ^ Büttner, Petra; Garbe, Claus; Bertz, Jochen; Burg, Günter; d'Hoedt, Barbara; Drepper, Hubert; Guggenmoos-Holzmann, Irene; Lechner, Walter; et al. (1995). "Primary cutaneous melanoma. Optimized cutoff points of tumor thickness and importance of clark's level for prognostic classification". Cancer 75 (10): 2499–2506.  
  3. ^ Buzaid, AC; Ross, MI; Balch, CM; Soong, S; McCarthy, WH; Tinoco, L; Mansfield, P; Lee, JE; et al. (1997). "Critical analysis of the current American Joint Committee on Cancer staging system for cutaneous melanoma and proposal of a new staging system". Journal of clinical oncology 15 (3): 1039–51.  
  4. ^ a b Balch, CM; Soong, SJ; Gershenwald, JE; Thompson, JF; Reintgen, DS; Cascinelli, N; Urist, M; McMasters, KM; et al. (2001). "Prognostic factors analysis of 17,600 melanoma patients: Validation of the American Joint Committee on Cancer melanoma staging system". Journal of clinical oncology 19 (16): 3622–34.  
  5. ^ Rousseau, Dennis L.; Ross, Merrick I.; Johnson, Marcella M.; Prieto, Victor G.; Lee, Jeffrey E.; Mansfield, Paul F.; Gershenwald, Jeffrey E. (2003). "Revised American Joint Committee on Cancer Staging Criteria Accurately Predict Sentinel Lymph Node Positivity in Clinically Node-Negative Melanoma Patients". Annals of Surgical Oncology 10 (5): 569–74.  
  6. ^ a b Weedon, D. Skin pathology. 2nd Edition. 2002. Sydney: Churchill-Livingstone. ISBN 0-443-07069-5


Five anatomical levels are recognized, and higher levels have worsening prognostic implications. These levels are:

Clark's level is a related staging system, used in conjunction with Breslow's depth, which describes the level of anatomical invasion of the melanoma in the skin.[6] 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 (2010) AJCC staging system, Clark's level has prognostic significance only in patients with very thin (Breslow depth <1 mm) melanomas.[4]

Clark's level

Breslow thickness in the presence of ulceration also gives useful prognostic information.

Survival figures from British Association of Dermatologist Guidelines 2002

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

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.

Tumor depth is one of the cornerstones of the current AJCC TNM staging of malignant melanoma. A large study validated the importance of tumor depth (but not Breslow's original description) 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]

Prognostic importance

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).

Tumor 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. Tumor depth cannot be calculated from a shave biopsy that only contains a portion of the tumor because it leads to an underestimation of its thickness.


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.

. Breslow's depth eponym In recognition of his contribution, the depth of invasion of melanoma is referred to by the [1]

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