Recently, Zelger et al. found that metallothionein expression in melanoma is a useful prognostic indicator in white patients. In this study, we evaluated metallothionein expression in patients with melanoma as a prognostic indicator. We studied the tumors of 44 patients with cutaneous melanoma seen in our clinic from July 1988 to August 1998. Twenty-five neoplasms were metallothionein-positive, and 19 were metallothionein-negative. Only 9 (37.5%) of 24 cases of level I through III melanoma were positive for metallothionein, but 16 (80%) of 20 level IV and V cases were positive. Eight (40%) of 20 cases of "thin" melanoma (thickness: < or = 1.5 mm) were metallothionein-positive, and 17 (70.8%) of 24 cases of "thick" melanoma (thickness: > 1.5 mm) were metallothionein-positive. These results indicate a strong correlation of metallothionein expression with the level of invasion and tumor thickness in melanoma. The survival distribution function curve (Kaplan-Meier) for metallothionein expression showed a much better survival rate in the metallothionein-negative group than in the metallothionein-positive group.