Invasive Primary Cutaneous Melanoma Research Articles

Increases in invasive melanoma in England, 1979–2006, by anatomical site

National melanoma incidence trends with details of anatomical site have not been previously described for England. To describe site-specific trends in cutaneous melanoma for England as a whole during the last three decades. Anonymized data, 1979-2006, were obtained from national cancer registrations of all patients in England up to age 89years with incident primary invasive cutaneous melanomas (n=124055). Sex-specific age-standardized incidence rates and average annual percentage change in rates were calculated for each broad anatomical site. Overall incidence rates of cutaneous melanoma in England, 1979-2006, were 81 and 100 per million, in males and females, respectively. Site-specific rates were consistently highest on the lower limbs in females followed by the trunk in males. Greatest annual increases occurred on the trunk in both sexes over 45years (males 9·9%, females 6·8%), then upper limbs (males 8·7%, females 6·8%). Incidence trends in males relative to females varied little across sites apart from a more rapid rise in head/neck melanomas in males than in females after the 1980s. Invasive melanoma rates continue to rise in England, particularly on the trunk and arms, and in males on the head/neck. The steeper increases in melanoma rates among males are consistent with their greater sun exposure and poorer compliance with sun protection measures than females.

Association between melanoma thickness, clinical skin examination and socioeconomic status: Results of a large population‐based study

Survival from melanoma is inversely related to tumour thickness and is less favorable for those in lower socioeconomic (SES) strata. Reasons for this are unclear but may relate to a lower prevalence of skin screening. Our aim was to examine the association between melanoma thickness, individual-level SES and clinical skin examination (CSE) using a population-based case-control study. Cases were Queensland (Australia) residents aged 20-75 years with a histologically confirmed first primary invasive cutaneous melanoma diagnosed between January 2000 and December 2003. Telephone interviews were completed by 3,762 cases (77.7%) and 3,824 (50.4%) controls. Thickness was dichotomized to thin (≤2 mm) and thick (>2 mm). Compared with controls, the risk of thick melanoma was significantly increased among men [relative risk ratio (RRR) = 1.56, 95% CI = 1.22-2.00], older participants (RRR = 1.76, 95% CI = 1.10-2.82), those educated to primary level (RRR = 1.70, 95% CI = 1.08-2.66), not married/living as married (RRR = 1.47, 95% CI = 1.15-1.88), retired (RRR = 1.39, 95% CI = 1.01-1.94) and not having a CSE in past 3 years (RRR = 1.45, 95% CI = 1.12-1.86). There was a significant trend to increasing prevalence of CSE with higher education (p < 0.01) and the benefit of CSE in reducing the risk of thick melanoma was most pronounced among that subgroup. There were no significant associations between cases with thin melanoma and controls. Melanoma thickness at presentation is significantly associated with educational level, other measures of SES and absence of CSE. Public health education efforts should focus on identifying new avenues that specifically target those subgroups of the population who are at increased risk of being diagnosed with thick melanoma.

Prognostic Usefulness of Sentinel Lymph Node Biopsy for Patients Who Have Clinically Node Negative, Localized, Primary Invasive Cutaneous Melanoma

To assess the prognostic value of sentinel lymph node biopsy status for patients with localized, clinically node negative, primary invasive cutaneous melanoma. Predictive value of positive or negative sentinel lymph node biopsy (SLNB) results for melanoma-related death, using raw numbers from informative publications. Reports comprising 50 patients with cutaneous melanoma who had undergone SLNB, based on PubMed search (January 1, 1993, through June 3, 2010). Melanoma-related death. For the 2 informative reports of patients with tumors of intermediate thickness (1-4 mm), risk of melanoma-related death ranged from 26.2% to 31.6% for node-positive cases and from 9.7% to 15.6% for node-negative cases. Based on 4 informative reports of patients with thin tumors (≤ 1 mm), risk of melanoma-related death ranged from 0% to 0.6% for both node-positive and node-negative cases. For the single informative report of patients with thick tumors (≥ 4 mm), risk of melanoma-related death was 32.5% for node-positive cases and 30.1% for node-negative cases. For 19 informative case series with any tumor thickness, risk of melanoma-related death ranged from 0% to 47.8% for node-positive cases and from 0% to 13.3% for node-negative cases. Prognostic information provided by SLNB status may be variably useful for patients who have tumors of intermediate thickness (1-4 mm) and not very useful for patients who have thin (≤ 1 mm) or thick (≥ 4 mm) tumors.

Patterns of GRP78 and MTJ1 expression in primary cutaneous malignant melanoma

Cell surface expression of glucose-regulated protein 78 (GRP78) occurs in several types of cancer; however, its role in the behavior of primary cutaneous melanoma is not well studied. The association of cell surface GRP78 with other proteins such as MTJ1 stimulates cell proliferation. In this study, we characterized the pattern of expression of GRP78 and MTJ1 in invasive primary cutaneous melanomas and analyzed the relationships between the pattern of expression and various clinicopathological parameters. We found two patterns of GRP78 expression in invasive primary cutaneous melanoma. One pattern showed a gradual fading of protein expression from superficial to deeper levels within the same tumor. The second pattern of expression showed a similar fading with an abrupt regaining of expression at the deep invasive edge of the melanoma. These two distinct patterns of GRP78 expression correlated with both patient survival and depth of tumor invasion. A moderate MTJ1 expression was found to be associated with decreased patient survival; however, no significant associations were observed between patterns of GRP78 and MTJ1 expression. Our study (1) describes two distinct patterns of GRP78 in invasive primary cutaneous melanoma, (2) inversely correlates regain of GRP78 expression with patient survival, and (3) suggests a modifying effect of MTJ1 on GRP78 in enhancing tumor aggressiveness.

Clinical whole‐body skin examination reduces the incidence of thick melanomas

Survival from melanoma is strongly related to tumour thickness, thus earlier diagnosis has the potential to reduce mortality from this disease. However, in the absence of conclusive evidence that clinical skin examination reduces mortality, evidence-based assessments do not recommend population screening. We aimed to assess whether clinical whole-body skin examination is associated with a reduced incidence of thick melanoma and also whether screening is associated with an increased incidence of thin lesions (possible overdiagnosis). We conducted a population-based case-control study of all Queensland residents aged 20-75 years with a histologically confirmed first primary invasive cutaneous melanoma diagnosed between January 2000 and December 2003. Telephone interviews were completed by 3,762 eligible cases (78.0%) and 3,824 eligible controls (50.4%). Whole-body clinical skin examination in the three years before diagnosis was associated with a 14% lower risk of being diagnosed with a thick melanoma (>0.75 mm) (OR = 0.86, 95% CI = 0.75, 0.98). Risk decreased for melanomas of increasing thickness: the risk of being diagnosed with a melanoma 0.76-1.49 mm was reduced by 7% (OR = 0.93, 95% CI 0.79, 1.10), by 17% for melanomas 1.50-2.99 mm (OR = 0.83, 95% CI = 0.65, 1.05) and by 40% for melanomas > or =3 mm (OR = 0.60, 95% CI = 0.43, 0.83). Screening was associated with a 38% higher risk of being diagnosed with a thin invasive melanoma (< or =0.75 mm) (OR = 1.38, 95% CI = 1.22, 1.56). This is the strongest evidence to date that whole-body clinical skin examination reduces the incidence of thick melanoma. Because survival from melanoma is strongly related to tumour thickness, these results suggest that screening would reduce melanoma mortality.

Factors related to the presentation of thin and thick nodular melanoma from a population‐based cancer registry in Queensland Australia

Worldwide, the incidence of thick melanoma has not declined, and the nodular melanoma (NM) subtype accounts for nearly 40% of newly diagnosed thick melanoma. To assess differences between patients with thin (<or=2.00 mm) and thick (>or=2.01 mm) nodular melanoma, the authors evaluated factors such as demographics, melanoma detection patterns, tumor visibility, and physician screening for NM alone and compared clinical presentation and anatomic location of NM with superficial spreading melanoma (SSM). The authors used data from a large population-based study of Queensland (Australia) residents diagnosed with melanoma. Queensland residents aged 20 to 75 years with histologically confirmed first primary invasive cutaneous melanoma were eligible for the study, and all questionnaires were conducted by telephone (response rate, 77.9%). During this 4-year period, 369 patients with nodular melanoma were interviewed, of whom 56.7% were diagnosed with tumors <or=2.00 mm. Men, older individuals, and those who had not been screened by a physician in the past 3 years were more likely to have nodular tumors of greater thickness. Thickest nodular melanoma (4 mm+) was also most common in persons who had not been screened by a physician within the past 3 years (odds ratio, 3.75; 95% confidence interval, 1.47-9.59). Forty-six percent of patients with thin nodular melanoma (<or=2.00 mm) reported a change in color, compared with 64% of patients with thin SSM and 26% of patients with thick nodular melanoma (>2.00 mm). Awareness of factors related to earlier detection of potentially fatal nodular melanomas, including the benefits of a physician examination, should be useful in enhancing public and professional education strategies. Particular awareness of clinical warning signs associated with thin nodular melanoma should allow for more prompt diagnosis and treatment of this subtype.

Time trends in tumour thickness vary in subgroups: analysis of 6475 patients by age, tumour site and melanoma subtype

An elevated tumour thickness is strongly associated with an increased risk of mortality in melanoma patients. In the last few decades, an overall decrease of the tumour thickness to prognostically more favourable levels has been observed in several countries. Nevertheless, it is not clear whether this positive time trend occurred uniformly in specific subgroups of melanoma patients. Therefore, we aimed to assess time trends of tumour thickness by age group, tumour site and melanoma subtype. The study population consisted of 6475 patients with histologically proven primary invasive cutaneous melanomas seen at the Department of Dermatology and Allergology at the Ludwig-Maximilian-University Munich between 1977 and 2000. Age-adjusted time trends were assessed using linear and logistic regression analysis. Overall, a positive time trend with a decreasing tumour thickness was observed during the observation period in most subgroups. However, no significant time trend was observed in patients with a melanoma on the feet or with a nodular or acrolentiginous melanoma. The almost constant high tumour thickness of these patients might be caused by underaddressing the specific traits of these melanomas in earlier prevention campaigns. An important goal for the upcoming years should consist of a positive time trend with a decreasing tumour thickness in these subgroups.

Incidence of Cutaneous Malignant Melanoma in the Ottawa Region: 1996 to 2006

The incidence rates of invasive primary cutaneous malignant melanoma in Canada have shown a gradual tapering in recent years, after decades of increases. This trend suggests that the incidence of melanoma in Canada is stabilizing; however, knowledge of the recent trend for both in situ and invasive tumors was lacking. The purpose of this study was to examine the temporal trend of both in situ and invasive melanoma within the Ottawa region over a 10-year period. The histopathology of cutaneous melanomas diagnosed in the Ottawa region was obtained for the years 1996, 2001, and 2006 from the main diagnostic centers servicing the area; however, not all melanomas have been accounted for. All rates are expressed per 100,000 population per year. Melanoma incidence decreased between 1996 and 2001 (-3.83) and increased between 2001 and 2006 (+7.46; p < or = .05). This increase is mainly attributable to in situ melanoma (+5.49; p < or = .05). There has been no statistically significant change in invasive melanoma. Invasive melanoma incidence in the Ottawa region remained stable, whereas in situ melanoma incidence increased.

An evidence base for reconsidering current follow-up guidelines for patients with cutaneous melanoma less than 05mm thick at diagnosis

Despite current guidelines, there is uncertainty about the required duration and frequency of follow-up visits for patients with invasive primary cutaneous melanoma < 0.5 mm thick. To review patients with invasive melanoma thinner than 0.5 mm followed for at least 5 years to provide an evidence base for considering modification of guidelines. A retrospective review of 430 patients diagnosed in the west of Scotland during 1992-2001 with melanoma < 0.5 mm was carried out. Recurrence, deaths from melanoma and second primary melanomas were all identified. From 1992 to 2001, 430 melanomas < 0.5 mm thick at diagnosis were diagnosed out of a total of 3036 primary cutaneous melanomas. To date there have been 593 deaths from melanoma (19%) in the whole group. Five of these deaths were reported in patients with melanomas < 0.5 mm, but on pathological review two were thicker than 0.5 mm at diagnosis (1.5 and > 3 mm), and the remaining three patients all developed thicker second primary melanomas (2.7, 12.0 and 19.0 mm) with a recurrence pattern and timing indicating that these thicker primaries were the cause of death. Fourteen further patients developed a second primary melanoma, and 13 are currently alive and disease free, one dying of other causes. Our data indicate that recurrence and subsequent death from melanomas < 0.5 mm is a very rare event, and that quarterly follow-up for 3 years will yield very few events. Modification of current guideline recommendations are suggested to include a period of patient education concentrating on recognition of second primary tumours followed by rapid access to an expert opinion if required.

Management of primary and metastasized melanoma in Germany in the time period 1976–2005: an analysis of the Central Malignant Melanoma Registry of the German Dermatological Society

This study analysed the changes of excision margins in correlation with tumour thickness as recorded over the last three decades in Germany. The study also evaluated surgical management in different geographical regions and treatment options for metastasized melanoma. A total of 42 625 patients with invasive primary cutaneous melanoma, recorded by the German Central Malignant Melanoma Registry between 1976 and 2005 were included. Multiple linear regression analysis was used to investigate time trends of excision margins adjusted for tumour thickness. Excision margins of 5.0 cm were widely used in the late 1970s but since then have been replaced by smaller margins that are dependent on tumour thickness. In the case of primary melanoma, one-step surgery dominated until 1985 and was mostly replaced by two-step excisions since the early 1990s. In eastern Germany, one-step management remained common until the late 1990s. During the last three decades loco-regional metastases were predominantly treated by surgery (up to 80%), whereas systemic therapy decreased. The primary treatment of distant metastases has consistently been systemic chemotherapy. This descriptive retrospective study revealed a significant decrease in excision margins to a maximum of 2.00 cm. A significant trend towards two-step excisions in primary cutaneous melanoma was observed throughout Germany. Management of metastasized melanoma showed a tendency towards surgical procedures in limited disease and an ongoing trend to systemic treatment in advanced disease.

Impact of sentinel lymphadenectomy on survival in a murine model of melanoma

Lymphatic mapping and sentinel lymph node biopsy-also termed sentinel lymphadenectomy (SL)-has become a standard of care for patients with primary invasive cutaneous melanoma. This technique has been shown to provide accurate information about the disease status of the regional lymph node basins at risk for metastasis, provide prognostic information, and provide durable regional lymph node control. The potential survival benefit afforded to patients undergoing SL is controversial. Central to this controversy is whether metastasis to regional lymph nodes occurs independent of or prior to widespread hematogenous dissemination. A related area of uncertainty is whether tumor cells residing within regional lymph nodes have increased metastatic potential. We have used a murine model of primary invasive cutaneous melanoma based on injection of B16-BL6 melanoma cells into the pinna to address two questions: (1) does SL plus wide excision of the primary tumor result in a survival advantage over wide excision alone; and (2) do melanoma cells growing within lymph nodes produce a higher incidence of hematogenous metastases than do cells growing at the primary tumor site? We found that SL significantly improved the survival of mice with small primary tumors. We found no difference in the incidence of lung metastases produced by B16-BL6 melanoma cells growing exclusively within regional lymph nodes and cells growing within the pinna.

Metamorphosis of melanoma. Trends in size and thickness of cutaneous melanoma over one decade at the Istituto Nazionale Tumori, Milan

Messages about the description of the clinical features of cutaneous melanoma (CM) have remained unchanged since 1985, when the ABCD (Asymmetry, Border irregularity, Color variegation, Diameter >6 mm) rule for melanoma detection was formulated. Given the significant shift to the diagnosis of earlier-stage CMs over the past decades, it is reasonable to think that also the clinical aspects of the disease might have changed. The aim of this study was to examine trends in the presentation of CM over the last decade at our Institution, focusing on two characteristics of the disease: size and thickness. A retrospective study was conducted including 1,603 primary invasive CMs seen and treated at the Unit for Melanoma Detection at our Institute between January 1997 and December 2006. The results showed a trend towards smaller CMs, with a difference of 3 mm in median size from the beginning to the end of the period. Detection of small (< or =6 mm) CMs increased at a rate of about 1.5% per year, with a current ratio of 25% with respect to all CMs. Thickness remained substantially unchanged over time. Physicians must be aware that the characteristics of melanoma have undergone a metamorphosis over the years and the ABCD signs cannot be relied on for adequate sensitivity to further the early detection of CM.

Cutaneous melanoma in the Maltese Islands: 2000–2004

This study aimed to, prospectively, over the 5-year period 2000–2004, accurately determine features of cutaneous melanoma in the Maltese Islands. Data from clinicians were supplemented by histology reports, and where necessary, histology slides were reviewed. Information collected included demographic details including age and gender, anatomical site, Clark’s level, Breslow thickness and clinico-pathological melanoma type. During the study period the age-standardised (European Standard Population) rates for invasive melanoma were 8.81 per 100,000 (males) and 7.29 per 100,000 (females) and increased with age. By the end of the study, information on 166 cases of primary invasive cutaneous malignant melanoma were collected. The commonest site affected in males was the trunk (54%) and in females the lower limbs (41%). Overall, 33.8% of invasive melanomas had a Breslow thickness >1.5 mm. The initial melanoma excision was performed by a dermatologist in 68.2% and plastic surgeon in 20.8%. More cases presented in late spring and summer, particularly in females. Melanoma incidence in Malta is lower than that in high-incidence countries and northern Europe and is similar to that in southern Europe. However, incidence appears to be increasing and a relatively high proportion of patients present with thick lesions emphasising the importance of continued efforts to diagnose cases earlier.

Factors associated with a high tumour thickness in patients with melanoma

Prognosis of patients with melanoma is strongly associated with tumour thickness at time of diagnosis. Therefore, knowledge of patient characteristics and behaviour associated with a high tumour thickness is essential for the development and improvement of melanoma prevention campaigns. The present study aimed to identify sociodemographic, clinical and behavioural factors associated with high tumour thickness according to Breslow. The study population consisted of 217 patients with histologically proven primary invasive cutaneous melanomas seen at the Department of Dermatology and Allergology at the Ludwig-Maximilian-University Munich, Germany, between January 1999 and January 2001. Personal interviews were conducted by two physicians to obtain information on sociodemographic characteristics and on patients' knowledge of melanoma symptoms, sun behaviour, delay in diagnosis and related factors. Multivariate linear and logistic regression analysis with stepwise variable selection was used to identify risk groups with a high tumour thickness. To assess possible effect modifications, interaction terms were included in the regression analysis. The median tumour thickness was 0.8 mm (interquartile range 0.5-1.6). Fifty-seven patients (26%) had tumour thickness >1.5 mm. In a multivariate linear regression analysis, patients living alone and patients with a low educational level showed a significantly greater tumour thickness. The relation of melanoma knowledge to tumour thickness was modified by the melanoma subtype: whereas lack of melanoma knowledge led to an increased tumour thickness for the subtypes superficial spreading melanoma, lentigo maligna melanoma and unspecified malignant melanoma, no significant effect was estimated for the subtypes nodular melanoma (NM) and acrolentiginous melanoma (ALM). Sex, age, self-detection of melanoma, patient delay and professional delay were not significantly associated with the tumour thickness in multivariate linear regression. Similar results were found in multivariate logistic regression. An increased tumour thickness was found in subjects living alone and having a low educational level. These subjects should be targeted in future prevention campaigns in a more focused way. Further efforts are necessary to improve knowledge and earlier detection of melanoma subtypes NM and ALM.

Ethnic Differences Among Patients With Cutaneous Melanoma

Melanoma incidence continues to increase in whites, but little is known about melanoma in minority populations. Surveillance, Epidemiology, and End Results (SEER) data were used to examine the incidence, manifestations, and survival in patients with melanoma with respect to race/ethnicity. A SEER search (1992-2002) for primary invasive cutaneous melanoma cases identified 48 143 whites, 932 Hispanics, 394 Asian/Pacific islanders, 251 African Americans, and 52 American Indians. Multivariate analyses were performed to evaluate the relationship between race/ethnicity and clinicopathologic factors; associations between race/ethnicity and survival were examined using the Cox proportional hazards model. Based on our cohort of patients, the average annual age-adjusted melanoma incidence per 100 000 persons was 18.4 for whites compared with 2.3, 0.8, 1.6, and 1.0 for Hispanics, African Americans, American Indians, and Asians, respectively. Lower extremity and acral lentiginous melanomas were more common among minorities. Overall 5-year survival was 72.2% to 81.1% for minorities compared with 89.6% for whites. A 1.96- to 3.01-fold greater risk of disease-specific mortality persisted in minorities compared with whites after adjusting for age, sex, and region. In addition, Hispanics (odds ratio [OR], 3.6), African Americans (OR, 4.2), American Indians (OR, 3.4), and Asians (OR, 2.4) were more likely to present with stage IV melanoma than were whites. African Americans had a 1.48-fold higher rate of risk-adjusted, stage-specific mortality compared with whites. Melanoma is a public health concern for all ethnic populations. Differences in disease stage at presentation contributes to disparities in survival. Understanding melanoma in minority populations may lead to early detection and ultimately save lives.

CXCR3 chemokine receptor immunoreactivity in primary cutaneous malignant melanoma: correlation with clinicopathological prognostic factors

Background: A role for CXCR3, the receptor for chemokines Mig, IP-10 and interferon-inducible T cell α-chemoattractant, in tumour cell migration during melanoma progression has been proposed. Aims: To analyse CXCR3...

A Population-Based Validation of the American Joint Committee on Cancer Melanoma Staging System

A major revision of the American Joint Committee on Cancer (AJCC) stages for melanoma was implemented in 2002 after its validation in multinational cohorts including patients from cancer centers and cooperative groups. This staging system has not been validated in a US population-based cohort. We used 41,417 patients with primary invasive cutaneous melanoma diagnosed between 1988 and 2001 from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) cancer registry to validate the revised AJCC staging system. Survival rates computed from stage-specific Kaplan-Meier curves (time to melanoma-specific death) were compared with the survival rates from 17,600 patients in the original AJCC validation study. In the SEER cohort, 65% of reported melanomas were < or = 1.00 mm in thickness and 8.7% were more than 4.00 mm compared with 39% and 10% in the AJCC cohort (P < .001), respectively. AJCC stages were able to discriminate among SEER patient groups with different prognosis. However, SEER survival rates were significantly higher than those in the AJCC study and notably so in patients with T1a lesions (< or = 1 mm without ulceration). This population-specific effect remained significant after controlling for lesion thickness in all substages except stage IIA. Although this national population-based study validates the most recent revision of AJCC stages for melanoma, it emphasizes that survival rates are population specific and found them to be generally higher for SEER compared with AJCC patients. Population-specific survival rates should be used in study designs and decisions about patient-specific interventions.

Prognostic factors of thin cutaneous melanoma: an analysis of the central malignant melanoma registry of the german dermatological society.

The increasing number of thin cutaneous melanomas (CM) with tumor thickness up to 1 mm demands a detailed analysis of prognostic factors for the classification and grading of these tumors. The aim of the present study was to identify prognostic factors in thin CM. A series of 12,728 patients with thin incident primary invasive CM and follow-up data recorded between 1976 and 2000 by the German-based Central Malignant Melanoma Registry was analyzed using the multivariate Cox proportional hazard model to evaluate prognostic factors, and classification and regression trees analysis (CART) to define prognostic groups. Multivariate analysis found tumor thickness, sex, age, body site, and histopathologic subtype to be significant prognostic factors of thin CM. Ulceration and regression did not affect prognosis significantly. Prognostic classification based on the results of CART analysis resulted in three groups defined by tumor thickness, age, and sex. Ten-year survival rates of these groups varied between 91.8% and 98.1%, with improved classification as compared with subgroups by tumor thickness alone. Classification by tumor thickness identified prognostic subgroups with highest significance in thin CM, and the classification was improved by the introduction of age and sex. However, neither ulceration nor the level of invasion included in the new American Joint Committee on Cancer TNM system classification, revealed statistical significance as prognostic factors in thin CM.

A population-based validation of the AJCC melanoma staging system

7500 Background: A major revision of the AJCC stages for melanoma was implemented in 2002 after validation in populations from cancer centers and cooperative groups. Methods: In this study, the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) cancer registry was used to validate the new AJCC staging system. 36,190 patients with primary invasive cutaneous melanoma diagnosed between 1988 and 2000 were identified. Survival rates computed from stage-specific Kaplan Meier curves (time to melanoma-specific death) were compared to the rates from 14,670 patients in the original validation study (Balch, et. al. JCO 19:3635–48, 2001). Cox proportional hazard models were used to identify significant prognostic factors. Results: 68% of SEER melanomas were ≤ 1.00 mm and 5% were > 4.00 mm compared respectively to 39% and 10% in the original study (p<0.001). As in the original study, Stage I, II and III melanomas with ulceration had lower survival rates, equivalent to the next higher stage. The 10-year survival rates and standard errors (SE) are presented below for stages with ≥ 900 SEER patients and from the original study. SEER rates were significantly higher than those in the original study in 15 of the 16-stage categories and notably so in T1a patients. For lesions ≤1.00, 1.01–2.00 and 2.01–4.00 mm, level, ulceration, age, sex, and site were statistically significant prognostic factors. SEER associations between survival and the prognostic factors were stronger than those in the original study, except for ulceration in lesions 2.01–4.00 mm. Conclusions: While this population-based study validates the new AJCC stages, it emphasizes that risk estimates are population specific. No significant financial relationships to disclose.

A population-based validation of the AJCC melanoma staging system

7500 Background: A major revision of the AJCC stages for melanoma was implemented in 2002 after validation in populations from cancer centers and cooperative groups. Methods: In this study, the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) cancer registry was used to validate the new AJCC staging system. 36,190 patients with primary invasive cutaneous melanoma diagnosed between 1988 and 2000 were identified. Survival rates computed from stage-specific Kaplan Meier curves (time to melanoma-specific death) were compared to the rates from 14,670 patients in the original validation study (Balch, et. al. JCO 19:3635–48, 2001). Cox proportional hazard models were used to identify significant prognostic factors. Results: 68% of SEER melanomas were ≤ 1.00 mm and 5% were > 4.00 mm compared respectively to 39% and 10% in the original study (p<0.001). As in the original study, Stage I, II and III melanomas with ulceration had lower survival rates, equivalent to the next higher stage. The 10-year survival rates and standard errors (SE) are presented below for stages with ≥ 900 SEER patients and from the original study. SEER rates were significantly higher than those in the original study in 15 of the 16-stage categories and notably so in T1a patients. For lesions ≤1.00, 1.01–2.00 and 2.01–4.00 mm, level, ulceration, age, sex, and site were statistically significant prognostic factors. SEER associations between survival and the prognostic factors were stronger than those in the original study, except for ulceration in lesions 2.01–4.00 mm. Conclusions: While this population-based study validates the new AJCC stages, it emphasizes that risk estimates are population specific. No significant financial relationships to disclose.