Poor prognosis for thin ulcerated melanomas and implications for a more aggressive approach to treatment

Publication date: Available online 14 January 2019

Source: Journal of the American Academy of Dermatology

Author(s): Makenzie L. Hawkins, Matthew J. Rioth, Megan M. Eguchi, Myles Cockburn

Abstract

Background

Clinical guidelines for the treatment of melanoma are based largely on the behavior of thicker tumors. As a result, little is known about survival differences among patients with thinner tumors.

Objective

To investigate the variability in survival for AJCC stage T1 thin melanoma tumors, defined as less than 1mm at diagnosis.

Methods

This population-based series included 43,008 non-Hispanic whites diagnosed with cutaneous melanoma between 2004 and 2013 from the California Cancer Registry. Survival outcomes estimated using the Kaplan-Meier Method. Cox proportional hazard models were used to estimate risk of death.

Results

Survival for patients with thin ulcerated tumors was comparable to patients with Stage II tumors, who are currently treated more aggressively. At 12 months, patients with thin ulcerated tumors had approximately 6% lower survival (92.5%, 95%CL:90.6-93.9%) compared to patients with thin non-ulcerated tumors (98.2%, 95%CL:98.0-98.3%). At 24 months, this survival difference increased (85.2% (95%CL: 82.8%-87.4%), 96.1% (95%CL:95.8-96.3%); respectively) and continued to increase over 2-fold by 60 months.

Limitations

Previous reports of cancer registry data have noted some evidence of miscoding of thin tumors.

Conclusion

The poorer survival in less than 1mm thick, ulcerated tumors implies the need for additional studies to determine potential benefits of more aggressive treatment.

http://bit.ly/2TQjvvq