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Journal of the American Academy of Dermatology

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The progressive relationship between increasing Breslow thickness and decreasing survival is lost in patients with ultrathick melanomas (≥15 mm in thickness) - 16/07/22

Doi : 10.1016/j.jaad.2022.01.040 
Mary-Ann El Sharouni, MD a, b, Robert V. Rawson, MBBS a, c, d, e, Vigfús Sigurdsson, MD b, Arjen J. Witkamp, MD f, Carla H. van Gils, PhD g, Richard A. Scolyer, MD a, c, d, e, h, John F. Thompson, MD a, c, i, ⁎ , Paul J. van Diest, MD j, Serigne N. Lo, PhD a, c
a Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia 
b Department of Dermatology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands 
c Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia 
d Department of Tissue Oncology and Diagnostic Pathology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia 
e NSW Health Pathology, Sydney, New South Wales, Australia 
f Department of Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands 
g Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands 
h Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, New South Wales, Australia 
i Department of Pathology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands 
j Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia 

∗Correspondence to: John F. Thompson, MD, Melanoma Institute Australia, The University of Sydney, 40 Rocklands Road, North Sydney, NSW 2060, Australia.Melanoma Institute AustraliaThe University of Sydney40 Rocklands RoadNorth SydneyNSW2060Australia

Abstract

Background

Survival tends to decrease as the Breslow thickness of a primary melanoma increases. However, little is known about the prognostic value of Breslow thickness in patients with very thick melanomas.

Objective

We sought to assess survival in patients with melanomas ≥4.0 mm in Breslow thickness.

Methods

A pooled cohort of 5595 patients (4107 Dutch and 1488 Australian) with melanomas ≥4.0 mm in thickness diagnosed from 2000 to 2014 was analyzed. Standard and spline Cox regressions were generated for overall survival (OS) and recurrence-free survival (RFS).

Results

The median follow-up was 3.4 years. The continuous hazard ratios (HRs) for OS and RFS increased steadily as the Breslow thickness increased to 15 mm, stabilized up to 20 mm, and decreased thereafter. Using patients with melanomas 4 to <10 mm thick as a reference group, the categoric HR for OS increased up to the 15- to -<20-mm thickness category and then decreased (HR, 1.46 [95% CI, 1.29-1.66], P < .0001 for 10-<15 mm; HR, 1.97 [95% CI, 1.55-2.51], P < .0001 for 15-<20 mm; and HR, 1.36 [95% CI, 1.07-1.84], P = .045 for ≥20 mm). For the RFS, similar trends were observed.

Limitations

Retrospective study. Small cohorts of patients with melanomas 15-<20mm and ≥20mm.

Conclusion

The progressive relationship between increasing Breslow thickness and decreasing survival is lost in patients with melanomas ≥15 mm in thickness.

Il testo completo di questo articolo è disponibile in PDF.

Key words : Breslow thickness, epidemiology, melanoma, prognosis, survival

Abbreviations used : CI, HR, MIA, OS, RFS, SN


Mappa


 Drs Thompson, van Diest, and Lo contributed equally to this article.
 Funding sources: Dr El Sharouni was supported by a Research Fellowship Grant from the European Association of Dermatology and Venereology. Author Rawson is supported by a Clinical Researcher Scholarship from Sydney Research. Drs Scolyer and Thompson are recipients of an Australian National Health and Medical Research Council (NHMRC) Program Grant (APP1093017), and Dr Scolyer is supported by an NHMRC Practitioner Fellowship (APP1141295). This research was also supported by a program grant from Cancer Institute New South Wales. Support from Melanoma Institute Australia, the Cameron Family, and the Ainsworth Foundation is also gratefully acknowledged.
 IRB approval status: Ethical approval for the use of the Dutch data was granted by the PALGA board, Netherlands and approval for use of the deidentified Australian data was obtained from the Human Research Ethics Committee of the Royal Prince Alfred Hospital, Sydney, Australia (Protocol X15-0454 & and HREC/11/RPAH/444).
 Reprints not available from the authors.


© 2022  American Academy of Dermatology, Inc.. Pubblicato da Elsevier Masson SAS. Tutti i diritti riservati.
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Vol 87 - N° 2

P. 298-305 - agosto 2022 Ritorno al numero
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