Psychological Factors in the Prognosis of Malignant Melanoma: A Prospective Study*

Sixty-four patients with clinical Stage 1 or II malignant melanoma who were apparently disease free rated the amount of adjustment needed to cope with their illness on a scale of 1 to 100. The resultant figure was called the melanoma adjustment score. Twenty-nine patients who relapsed within 1 year of surgery reported a score of 53 ± 31 (mean ± SD); 35 nonrelapsers reported a score of 80 ± 20, p < 0.001. Based upon analysis of individual melanoma adjustment scores in the first 31 patients, we predicted that subjects scoring> 65 would stay in remission, whereas those scoring < 65 would relapse. Applying this prospectively to the next 33 patients we correctly identified 25 of 33 outcomes (76%), p < 0.03. This psychological variable was inde-pendent of known biological prognostic factors, which did not predict 1 year survival. The melanoma adjustment score was also independent of the number of positive lymph nodes, which did correlate with outcome.in these patients. The results suggest a role for psychological factors in the one year prognosis of this malignancy