Distinct Clinicopathological and Prognostic Features of Thin Nodular Primary Melanomas: An International Study from 17 Centers. (13th March 2019)

• Record Type: Journal Article
• Authors: Dessinioti, Clio; Dimou, Niki; Geller, Alan C; Stergiopoulou, Aravella; Lo, Serigne; Keim, Ulrike; Gershenwald, Jeffrey E; Haydu, Lauren E; Ribero, Simone; Quaglino, Pietro; Puig, Susana; Malvehy, Josep; Kandolf-Sekulovic, Lidija; Radevic, Tatjana; Kaufmann, Roland; Meister, Laura; Nagore, Eduardo; Traves, Victor; Champsas, Grigorios G; Plaka, Mihaela; Dreno, Brigitte; Varey, Emilie; Ramirez, David Moreno; Dummer, Reinhard; Mangana, Joanna; Hauschild, Axel; Egberts, Friederike; Peris, Ketty; del Regno, Laura; Forsea, Ana-Maria; Zurac, Sabina A; Vieira, Ricardo; Brinca, Ana; Zalaudek, Iris; Deinlein, Teresa; Linos, Eleni; Evangelou, Evangelos; Thompson, John F; Scolyer, Richard A; Garbe, Claus; Stratigos, Alexander J;
• Is Part Of: Journal of the National Cancer Institute. Volume 111:Number 12(2019)
• Page Start: 1314
• Page End: 1322
• Publication Date: 2019-03-13
• Subjects: Cancer -- Periodicals; Cancer -- Research -- Periodicals; 616.994
• DOI: 10.1093/jnci/djz034
• Languages: English
• ISSNs: 0027-8874

Abstract

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 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.