5 research outputs found
Association of Skin Examination Behaviors and Thinner Nodular vs Superficial Spreading Melanoma at Diagnosis
Early melanoma detection strategies include skin self-examination (SSE), physician skin examination (PSE), and promotion of patient knowledge about skin cancer.To investigate the association of SSE, PSE, and patient attitudes with the detection of thinner superficial spreading melanoma (SSM) and nodular melanoma (NM), the latter of which tends to elude early detection.This cross-sectional, questionnaire-based, multicenter study identified patients with newly diagnosed cutaneous melanoma at 4 referral hospital centers in the United States, Greece, and Hungary. Among 920 patients with a primary invasive melanoma, 685 patients with SSM or NM subtype were included.A standardized questionnaire was used to record sociodemographic information, SSE and PSE practices, and patient perceptions in the year prior to diagnosis.Data were analyzed according to histologic thickness, with a 2-mm cutoff for thinner SSM and NM.Of 685 participants (mean [SD] age, 55.6 [15.1] years; 318 [46%] female), thinner melanoma was detected in 437 of 538 SSM (81%) and in 40 of 147 NM (27%). Patients who routinely performed SSE were more likely to be diagnosed with thinner SSM (odds ratio [OR], 2.61; 95% CI, 1.14-5.40) but not thinner NM (OR, 2.39; 95% CI, 0.84-6.80). Self-detected clinical warning signs (eg, elevation and onset of pain) were markers of thicker SSM and NM. Whole-body PSE was associated with a 2-fold increase in detection of thinner SSM (OR, 2.25; 95% CI, 1.16-4.35) and thinner NM (OR, 2.67; 95% CI, 1.05-6.82). Patient attitudes and perceptions focusing on increased interest in skin cancer were associated with the detection of thinner NM.Our findings underscore the importance of complementary practices by patients and physicians for the early detection of melanoma, including regular whole-body PSE, SSE, and increased patient awareness
Distinct Clinicopathological and Prognostic Features of Thin Nodular Primary Melanomas: An International Study from 17 Centers
Background: Nodular melanoma (NM) is more likely to be fatal compared
with 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), the United
States, and Australia between 2006 and 2015, were analyzed by
multivariable logistic regression analysis, with emphasis on thin (T1 <=
1.0mm) melanomas. Cox analysis assessed melanoma-specific survival. All
statistical tests were two sided.
Results: In all, 20 132 melanomas (NM: 5062, SSM: 15 070) were included.
Compared with T1 SSM, T1 NM was less likely to have regression (odds
ratio [OR] = 0.46, 95% confidence interval [CI] = 0.29 to 0.72) or
nevus remnants histologically (OR = 0.60, 95% CI = 0.42 to 0.85), and
more likely to have mitoses (OR = 1.97, 95% CI = 1.33 to 2.93) and
regional metastasis (OR = 1.77, 95% CI = 1.02 to 3.05). T1 NM had a
higher mitotic rate than T1 SSM (adjusted geometric mean = 2.2, 95% CI
= 1.9 to 2.5 vs 1.6, 95% CI = 1.5 to 1.7 per mm(2), P < .001). Cox
multivariable analysis showed a higher risk for melanoma-specific death
for NM compared with SSM for T1 (HR = 2.10, 95% CI = 1.24 to 3.56) and
T2 melanomas (HR = 1.30, 95% CI = 1.01 to 1.68), and after accounting
for center heterogeneity, the difference was statistically significant
only for T1 (HR = 2.20, 95% CI = 1.28 to 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 with 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