The progressive relationship between increasing Breslow thickness and decreasing survival is lost in patients with ultra-thick melanomas (≥15mm in thickness)
El Sharouni, Mary-Ann; Rawson, Robert V; Sigurdsson, Vigfús; Witkamp, Arjen J; van Gils, Carla H; Scolyer, Richard A; Thompson, John F; van Diest, Paul J; Lo, Serigne N
(2022) Journal of the American Academy of Dermatology, volume 87, issue 2, pp. 298 - 305
(Article)
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
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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.
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Keywords: Breslow thickness, epidemiology, melanoma, prognosis, survival, Dermatology, Journal Article
ISSN: 0190-9622
Publisher: Mosby Inc.
Note: Funding Information: 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). Funding Information: 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. Publisher Copyright: © 2022 American Academy of Dermatology, Inc.
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