Epidemiology of cutaneous melanoma in Sweden—Stage‐specific survival and rate of recurrence

Abstract

Cutaneous malignant melanoma (CMM) incidence is increasing globally, making a thorough understanding of the disease and its outcomes essential for optimizing care even more urgent. In this population-based, retrospective study, we investigated stage-specific survival and recurrence/progression rates of CMM among patients diagnosed in Stockholm County Council during 2005-2012, before the wide introduction of targeted therapy. A total of 3,554 CMM patients from the Stockholm Melanoma Register were included. Information on comorbidities, progression, death, and treatments was obtained from nationwide registers and hospital electronic medical records. Unadjusted 5-year survival varied from 91.4% for stage I to 24.6% for stage IV patients. Stage, age and gender were predictors of survival, with gender an independent predictor of survival for stages IA and IIA. 74.6% of patients remained recurrence/progression-free during follow-up, with 5-year recurrence/progression-free survival rates varying from 85.3% to 12.9% among stages I and IV patients, respectively. In addition to stage, male gender, and age, circulatory system comorbidities increased the risk for recurrence/progression. No statistically significant differences in progression rate for operated and non-operated patients could be detected, possibly due to high rate (98.9%) of surgery. Our estimates of survival and recurrence rates are consistent with historical and global expectations and can serve as a baseline to gauge population-level improvements with use of novel melanoma treatments.

Prognostic risk factors of first recurrence in patients with primary stages I–II cutaneous malignant melanoma – from the population‐based Swedish melanoma register

“…This study has shown that recurrence data could be collected from other registries in a region in Sweden with good structured data. A previous Swedish study from the Stockholm/Gotland region studied stage‐specific risk of progression/recurrence . The proportion of patients with metastasis found in that study was somewhat higher compared to our findings, but the inclusion criteria differed as the study included clinical stages III‐IV patients and also patients with a positive SNB.…”

Is the survival rate for acral melanoma actually worse than other cutaneous melanomas?

“…In addition, the OS of patients in stage 4 showed disparities depending on the metastases sites, where brain metastasis had the worst prognosis and was approximately seven times higher than that for lung metastasis . Meanwhile, in one study conducted in Sweden, the 5‐year stage‐specific survival were as follows: 91.4% for stage 1, 61.8% for stage 2, 56.9% for stage 3 and 24.6% for stage 4 . Accordingly, in our study, patients in stage 4 had significantly lower survival rates compared with those in other stages.…”

Considering adjuvant therapy for stage II melanoma

“…This may be a modest underestimation of the true stage II incidence because SEER data do not contain staging data for approximately 9% of cases. European data sets suggest that a range from 10% to 20% of all new cases present as stage II, smaller fractions present with stage III or IV disease, and the majority of new cases present as stage I, similar to US data (Fig. ) …”

“…Data from the Surveillance, Epidemiology, and End Results (SEER) program database were estimated using the percentage frequency distribution by stage derived from SEER*Stat software; specifically, patients who had newly diagnosed with melanoma in years 2011 through 2015 were used, and stage group was derived from the American Joint Committee on Cancer, 7th edition, for all ages combined. Data sources include the National Cancer Institute, 2018; Rockberg et al, 2016; and Schoffer et al, 2016 …”

“…1). [5][6][7] The AJCC has modified the melanoma staging system over time to account for a better understanding of histologic prognostic factors. Many early adjuvant melanoma trials and epidemiologic data incorporate AJCC version 6 (AJCCv6), whereas more modern melanoma adjuvant trials have used AJCC version 7 (AJCCv7).…”