Environmental Exposures Such as Smoking and Low Vitamin D Are Predictive of Poor Outcome in Cutaneous Melanoma rather than Other Deprivation Measures

C.M Hardie,F Elliott,M Chan,Z Rogers,D.T Bishop,J.A Newton-Bishop

doi:10.1016/j.jid.2019.05.033

C.M Hardie, F Elliott + Show 4 more

Open Access

https://doi.org/10.1016/j.jid.2019.05.033

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Abstract

A lack of basic resources within a society (deprivation) is associated with increased cancer mortality, and this relationship has been described for melanoma. We have previously reported the association of smoking and low vitamin D levels with melanoma death. In this study, we further explored the associations of these with melanoma in addition to deprivation and socio-economic stressors. In this analysis of 2,183 population-ascertained primary cutaneous melanoma patients, clinical, demographic, and socio-economic variables were assessed as predictors of tumor thickness, melanoma death and overall death. Using the Townsend deprivation score, the most deprived group did not have thicker tumors compared to the least deprived. Of the World Health Organization 25x25 risk factors for premature death, smoking and body mass index (BMI) were independently associated with thicker tumors. Low vitamin D was also independently associated with thicker tumors. No socio-economic stressors were independent predictors of thickness. Smoking was confirmed as a key predictor of melanoma death and overall death, as were low vitamin D levels, independent of other measures of deprivation. Neither BMI nor the Townsend deprivation score were predictive in either survival analysis. We report evidence for the role of smoking, vitamin D, and BMI in melanoma progression independent of a postcode-derived measure of deprivation.

Highlights

The most important prognostic factors for cutaneous primary melanoma are Breslow thickness (Balch et al, 2001; Breslow, 1979), microscopic ulceration status, the presence of tumor infiltrating lymphocytes, tumor mitotic rate, sex, age, and tumor site (Downing et al, 2006)
We have previously reported that smoking and vitamin D deficiency are associated with increased melanoma specific death in this cohort (Newton-Bishop et al, 2009; Newton-Bishop et al, 2015) and that smoking and increased body mass index (BMI) were associated with microscopic ulceration of the primary tumor
Fifty-nine participants did not have a Breslow thickness recorded, so they were excluded from the analysis of thickness

Summary

Introduction

The most important prognostic factors for cutaneous primary melanoma are Breslow thickness (thickness of the primary tumor in mm) (Balch et al, 2001; Breslow, 1979), microscopic ulceration status, the presence of tumor infiltrating lymphocytes, tumor mitotic rate, sex, age, and tumor site (Downing et al, 2006). We have previously reported that smoking and vitamin D deficiency are associated with increased melanoma specific death in this cohort (Newton-Bishop et al, 2009; Newton-Bishop et al, 2015) and that smoking and increased body mass index (BMI) were associated with microscopic ulceration of the primary tumor (a marker of poor prognosis). These three factors are associated with deprivation (Hiscock et al, 2012; Jaaskelainen et al, 2013; Mateo-Pascual et al, 2014; McLaren, 2007). We took a wider look at factors reported to be associated with socioeconomic deprivation, including those that are more difficult to quantitate, such as psychological stress

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