Distinct Clinicopathological and Prognostic Features of Thin Nodular Primary Melanomas: An International Study from 17 Centers

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 Unite...

Full description

Saved in:

Bibliographic Details
Published in:	JNCI : Journal of the National Cancer Institute Vol. 111; no. 12; pp. 1314 - 1322
Main 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
Format:	Journal Article
Language:	English
Published:	United States Oxford University Press 01-12-2019 Oxford Publishing Limited (England)
Subjects:	Confidence intervals Constellations Heterogeneity Medical prognosis Melanoma Metastases Metastasis Mitosis Nevus Regression analysis Statistical analysis Statistical tests Tumors
Online Access:	Get full text
Tags:	Add Tag No Tags, Be the first to tag this record!

Description
Summary:	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 mm2, 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.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 Claus Garbe and Alexander J. Stratigos contributed equally to this work as senior authors. See the Notes section for the full list of authors’ affiliations. Clio Dessinioti and Niki Dimou contributed equally to this work as first authors.
ISSN:	0027-8874 1460-2105
DOI:	10.1093/jnci/djz034