Brain metastases (BM) from cutaneous melanoma are associated with poor prognosis. Population-based data describing the associated factors of incidence and prognosis of BM from melanoma are still lacking. We identified 121 255 melanoma patients diagnosed during 2010–2015 from the Surveillance, Epidemiology, and End Results program, and identified predictive factors for incidence and survival of BM patients by using multivariable logistic and Cox’s proportional hazard regression, respectively. We identified 1547 patients with BM at the time of diagnosis of malignant cutaneous melanoma, representing 1.3% of the entire cohort and 35.4% of the subset with metastatic disease. The characteristics associated with higher BM incidence were male sex, age 40–60 years, melanoma location of face/head/neck, histologic type of nodular, higher T-stage, ulceration and extracranial metastases. The median overall survival and median cutaneous melanoma specific survival of patients with BM was 5 and 6 months, respectively. The relative factors of poor survival were older age and more extracranial metastatic sites. In summary, we provided insight into the epidemiology of BM from cutaneous melanoma. These results may provide significant help to improve the screening strategy of BM strategy and update the existing prognosis evaluation system.
BackgroundFor the melanoma patients who are with the primary tumor and metastatic disease concurrently (the newly diagnosed metastatic patients), the effect of primary tumor surgery on survival has never been discussed.ObjectiveWe sought to estimate this effect based on data from the Surveillance, Epidemiology, and End Results database.Patients and methodsWe identified patients with newly diagnosed metastatic melanoma from 2004 to 2015. The effect of primary tumor surgery was assessed by using Cox proportional hazard regression modeling and propensity score matching.ResultsEight thousand three hundred and forty-one patients who had been diagnosed with primary melanoma and metastatic disease at the same time were included in this analysis, of whom 2,554 (30.6%) received primary tumor surgery. In multivariable analysis of the unmatched cohort, primary tumor surgery was an independent protective factor of overall survival (HR =0.617, 95% CI 0.565–0.674; P<0.001) and melanoma-specific survival (HR =0.599, 95% CI 0.537–0.668; P<0.001). In the matched cohort, primary tumor surgery was still associated with better overall survival (13 vs 6 months, P<0.001) and melanoma-specific survival (18 vs 6 months, P<0.001).ConclusionOur results reveal the benefit of primary tumor surgery on the survival of patients with newly diagnosed metastatic melanoma and may fill in the gaps of guidelines for this population.IRBIRB approval is not required because the SEER data are freely accessible.
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