1. Distinct Clinicopathological and Prognostic Features of Thin Nodular Primary Melanomas: An International Study from 17 Centers
- Author
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Dessinioti, C., Dimou, N., Geller, A. C., Stergiopoulou, A., Lo, S., Keim, U., Gershenwald, J. E., Haydu, L. E., Ribero, S., Quaglino, P., Puig, S., Malvehy, J., Kandolf-Sekulovic, L., Radevic, T., Kaufmann, R., Meister, L., Nagore, E., Traves, V., Champsas, G. G., Plaka, M., Dreno, B., Varey, E., Ramirez, D. M., Dummer, R., Mangana, J., Hauschild, A., Egberts, F., Peris, Ketty, Del Regno, L., Forsea, A. -M., Zurac, S. A., Vieira, R., Brinca, A., Zalaudek, Iri, Deinlein, T., Linos, E., Evangelou, E., Thompson, J. F., Scolyer, R. A., Garbe, C., Stratigos, A. J., Peris K. (ORCID:0000-0002-5237-0463), Zalaudek I., Dessinioti, C., Dimou, N., Geller, A. C., Stergiopoulou, A., Lo, S., Keim, U., Gershenwald, J. E., Haydu, L. E., Ribero, S., Quaglino, P., Puig, S., Malvehy, J., Kandolf-Sekulovic, L., Radevic, T., Kaufmann, R., Meister, L., Nagore, E., Traves, V., Champsas, G. G., Plaka, M., Dreno, B., Varey, E., Ramirez, D. M., Dummer, R., Mangana, J., Hauschild, A., Egberts, F., Peris, Ketty, Del Regno, L., Forsea, A. -M., Zurac, S. A., Vieira, R., Brinca, A., Zalaudek, Iri, Deinlein, T., Linos, E., Evangelou, E., Thompson, J. F., Scolyer, R. A., Garbe, C., Stratigos, A. J., Peris K. (ORCID:0000-0002-5237-0463), and Zalaudek I.
- Abstract
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 ≤ 1.0 mm) 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 mm2, 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.
- Published
- 2019