Distinct clinicopathological and prognostic features of thin nodular primary melanomas: an international study from 17 centers
File(s)
Accepted version
Author(s)
Type
Journal Article
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.
Date Issued
2019-12-01
Date Acceptance
2019-03-08
Citation
JNCI: Journal of the National Cancer Institute, 2019, 111 (12), pp.1314-1322
ISSN
1460-2105
Publisher
Oxford University Press (OUP)
Start Page
1314
End Page
1322
Journal / Book Title
JNCI: Journal of the National Cancer Institute
Volume
111
Issue
12
Copyright Statement
© 2019 The Author(s). Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com
This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model). This is a pre-copy-editing, author-produced version of an article accepted for publication in JNCI: Journal of the National Cancer Institute following peer review. The definitive publisher-authenticated version [Clio Dessinioti, Niki Dimou, Alan C Geller, Aravella Stergiopoulou, Serigne Lo, Ulrike Keim, Jeffrey E Gershenwald, Lauren E Haydu, Simone Ribero, Pietro Quaglino, Susana Puig, Josep Malvehy, Lidija Kandolf-Sekulovic, Tatjana Radevic, Roland Kaufmann, Laura Meister, Eduardo Nagore, Victor Traves, Grigorios G Champsas, Mihaela Plaka, Brigitte Dreno, Emilie Varey, David Moreno Ramirez, Reinhard Dummer, Joanna Mangana, Axel Hauschild, Friederike Egberts, Ketty Peris, Laura del Regno, Ana-Maria Forsea, Sabina A Zurac, Ricardo Vieira, Ana Brinca, Iris Zalaudek, Teresa Deinlein, Eleni Linos, Evangelos Evangelou, John F Thompson, Richard A Scolyer, Claus Garbe, Alexander J Stratigos, Distinct clinicopathological and prognostic features of thin nodular primary melanomas: an international study from 17 centers, JNCI: Journal of the National Cancer Institute, , djz034, https://doi.org/10.1093/jnci/djz034] is available online at: https://dx.doi.org/10.1093/jnci/djz034
This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model). This is a pre-copy-editing, author-produced version of an article accepted for publication in JNCI: Journal of the National Cancer Institute following peer review. The definitive publisher-authenticated version [Clio Dessinioti, Niki Dimou, Alan C Geller, Aravella Stergiopoulou, Serigne Lo, Ulrike Keim, Jeffrey E Gershenwald, Lauren E Haydu, Simone Ribero, Pietro Quaglino, Susana Puig, Josep Malvehy, Lidija Kandolf-Sekulovic, Tatjana Radevic, Roland Kaufmann, Laura Meister, Eduardo Nagore, Victor Traves, Grigorios G Champsas, Mihaela Plaka, Brigitte Dreno, Emilie Varey, David Moreno Ramirez, Reinhard Dummer, Joanna Mangana, Axel Hauschild, Friederike Egberts, Ketty Peris, Laura del Regno, Ana-Maria Forsea, Sabina A Zurac, Ricardo Vieira, Ana Brinca, Iris Zalaudek, Teresa Deinlein, Eleni Linos, Evangelos Evangelou, John F Thompson, Richard A Scolyer, Claus Garbe, Alexander J Stratigos, Distinct clinicopathological and prognostic features of thin nodular primary melanomas: an international study from 17 centers, JNCI: Journal of the National Cancer Institute, , djz034, https://doi.org/10.1093/jnci/djz034] is available online at: https://dx.doi.org/10.1093/jnci/djz034
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/30863861
PII: 5377294
Subjects
Breslow thickness
Cutaneous melanoma
melanoma subtype
mitotic rate
nodular melanoma
pathology
prognosis
superficial spreading melanoma
survival
ulceration
Publication Status
Published
Coverage Spatial
United States
Date Publish Online
2019-03-13