Significant prognostic factors for CSS using a univariate model were Age (P = .013), Ulceration (P < .0001), Breslow’s Thickness (P < .0001), Mitotic rate (P < .0001), Clark’s level (P = .002), Distant metastasis (P < .0001), AJCC-stage (P < .0001) and p-Akt1 expression (P < .0001) Figure 1; while the unique independent prognostic factor in a multivariate analysis was Breslow Thickness (HR = 10.855, P = .041). This evidence concerns the gene AKT1 and ulcer disease.