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J Natl Cancer Inst. 2019 Mar 13. pii: djz034. doi: 10.1093/jnci/djz034. [Epub ahead of print]

Distinct clinicopathological and prognostic features of thin nodular primary melanomas: an international study from 17 centers.

Author information

1
Affiliations of authors: 1st Department of Dermatology-Venereology, National and Kapodistrian University of Athens, Andreas Sygros Hospital, Athens, Greece.
2
Department of Hygiene and Epidemiology, University of Ioannina Medical School, Ioaninna, Greece.
3
Department of Social and Behavioral Sciences, Harvard TH School of Public Health, Boston, MA, United States.
4
Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia.
5
Centre for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany.
6
Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center (MD Anderson), Houston, Texas, USA.
7
Department of Medical Sciences, Section of Dermatology, University of Turin, Turin, Italy.
8
Dermatology Department, Melanoma Unit, Hospital Clinic Barcelona, University of Barcelona, IDIBAPS, Barcelona& CIBERER, Instituto de Salud Carlos III, Barcelona, Spain.
9
Department of Dermatology, Medical Faculty, Military Medical Academy, Belgrade, Serbia.
10
Department of Dermatology, Venereology and Allergology Goethe-University Hospital, Frankfurt am Main, Germany.
11
Departments of Dermatology and Pathology, Instituto Valenciano de Oncología, Valencia, Spain.
12
Onco-dermatology department, CHU Nantes, CIC 1413, CRCINA, university Nantes, Nantes France.
13
Dermatology Department, Hospital Universitario Virgen Macarena, Seville-Spain.
14
Department of Dermatology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland.
15
Department of Dermatology and Venerology, University Hospital of Schleswig-Holstein, Campus Kiel, Germany.
16
Institute of Dermatology, Fondazione Policlinico Universitario A. Gemelli IRCCS - Catholic University, Rome, Italy.
17
Department of Oncologic Dermatology and Allergology, Elias University Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
18
Department of Pathology, Colentina Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
19
Coimbra Hospital and Universitary Centre, Coimbra, Portugal.
20
Dermatology Clinic, Maggiore Hospital, University of Trieste, Italy.
21
Division of Dermatology and Venerology, Medical University of Graz, Graz, Austria.
22
Program for Clinical Research, Department of Dermatology, University of California San Francisco, USA.
23
Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom.
24
Sydney Medical School, The University of Sydney, Sydney, Australia.
25
Royal Prince Alfred Hospital, Camperdown, Sydney, Australia.

Abstract

BACKGROUND:

Nodular melanoma (NM) is more likely to be fatal compared to other melanoma subtypes, an effect attributed to its greater Breslow thickness.

METHODS:

Clinicopathological features of NM and superficial spreading melanoma (SSM) diagnosed in 17 centers in Europe (n = 15), USA and Australia between 2006 and 2015, were analyzed by multivariate logistic regression analysis, with emphasis in thin (T1 ≤ 1.0 mm) melanomas. Cox analysis assessed melanoma-specific survival (MSS). All statistical tests were two-sided.

RESULTS:

In all, 20,132 melanomas (NM: 5,062, SSM: 15,070) were included. Compared to T1 SSM, T1 NM was less likely to have regression (OR: 0.46, 95% CI: 0.29-0.72) or nevus remnants histologically (OR: 0.60, 95% CI: 0.42-0.85), and more likely to have mitoses (OR: 1.97, 95% CI: 1.33-2.93) and regional metastasis (OR: 1.77, 95% CI: 1.02-3.05). T1 NM had a higher mitotic rate than T1 SSM (adjusted geometric mean 2.2 [95% CI:1.9-2.4] vs 1.6 [95% CI:1.5-1.7] per mm2, p < 0.001). Cox multivariate analysis showed a higher risk for melanoma-specific death for NM compared to SSM for T1 (HR: 2.10, 95% CI: 1.24-3.56) and T2 melanomas (HR: 1.30, 95% CI: 1.01-1.68), while after accounting for center heterogeneity, there was statistical significance only for T1 (HR: 2.20, 95% CI: 1.28-3.78). The NM subtype did not confer increased risk within each stratum (among localized tumors or cases with regional metastasis).

CONCLUSIONS:

T1 NM (compared to T1 SSM) was associated with a constellation of aggressive characteristics that may confer a worse prognosis. Our results indicate NM is a high-risk melanoma subtype that should be considered for inclusion in future prognostic classifications of melanoma.

KEYWORDS:

Breslow thickness; Cutaneous melanoma; melanoma subtype; mitotic rate; nodular melanoma; pathology; prognosis; superficial spreading melanoma; survival; ulceration

PMID:
30863861
DOI:
10.1093/jnci/djz034

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