Long‐term deaths from melanoma according to tumor thickness at diagnosis

Abstract

There is little long-term follow-up information about how the number of melanoma deaths and case fatality vary over time according to the measured thickness of melanoma at diagnosis. This population-based longitudinal cohort study examines patterns and trends in case fatality among 44,531 people in Queensland (Australia) diagnosed with a single invasive melanoma (International Classification of Diseases for Oncology, third revision [ICD-O-3], C44, Morphology 872-879) between 1987 and 2011, including 11,883 diagnosed between 1987 and 1996, with up to 20 years follow-up (to December 2016). The 20-year case fatality increased by thickness, with the percentage of melanoma deaths within 20 years of diagnosis being up to 4.8% for melanomas with measured thickness <0.80 mm, 10.6% for tumors 0.8 to <1.0 mm and generally more than 30% for melanomas measuring 3 mm and more. For melanomas <1.0 mm, most deaths occurred between 5 and 20 years after diagnosis, whereas for thicker melanomas the reverse was true with most deaths occurring within the first 5 years. Five-year case fatality decreased over successive calendar time periods for melanomas <1.0 mm, but not for melanomas ≥1.0 mm. These findings demonstrate that the time course for fatal melanomas varies markedly according to tumor thickness at diagnosis. Improved understanding of the patient factors and characteristics of melanomas, in addition to tumor thickness, which increase the likelihood of progression, is needed to guide clinical diagnosis, communication with patients and ongoing surveillance pathways of patients with potentially fatal lesions.

Cost‐effectiveness of a policy‐based intervention to reduce melanoma and other skin cancers associated with indoor tanning*

“…Published sex‐specific mortality data for England 13 were used to calculate the annual probabilities of dying from causes unrelated to melanoma, by subtracting the risk of dying from melanoma from all‐cause mortality estimates. For those with melanoma, an increased mortality risk was applied to the baseline population risk 22,23 using available epidemiological data 24,25 . For those with melanoma >1 mm, the increased yearly risk of melanoma death, starting at 0.06 in the year of diagnosis, was diminished annually to 0.006 in the 10th year and then persisted over the individual’s lifetime.…”

“…For those with melanoma, an increased mortality risk was applied to the baseline population risk 22,23 using available epidemiological data. 24,25 For those with melanoma >1 mm, the increased yearly risk of melanoma death, starting at 0.06 in the year of diagnosis, was diminished annually to 0.006 in the 10th year and then persisted over the individual's lifetime. For those with thin melanoma (≤ 1 mm), an increased annual lifetime risk was applied based on published survival data.…”

Can Patient-Led Surveillance Detect Subsequent New Primary or Recurrent Melanomas and Reduce the Need for Routinely Scheduled Follow Up? A Protocol for the MEL-SELF Randomised Controlled Trial.

“…Therefore, it is typically recommended that they undergo at least 10 years follow-up (and often longer), at intervals ranging from 3 to 12 months depending on melanoma stage [3,4]. Patients diagnosed with an early-stage melanoma have a very good prognosis in terms of life expectancy: those with melanoma in situ (stage 0) have the same mortality risk as the general population, and those with thin melanomas (<0.8 mm, which accounts for 65% of all invasive melanomas) have a 20-year survival of 80%-96% [5][6][7]. Clinician-led surveillance in the form of routinely scheduled clinic visits is widely accepted as the usual model of follow up care after removal of a melanoma, under the assumption that this leads to earlier detection and treatment a subsequent new primary or recurrent melanoma, and reduced mortality.…”

Surveillance of patients with thin melanoma

“…For these patients, the risk of distant recurrence or death is low, but when recurrence and death do occur, it is usually more than 5 years and up to 20 years later. 7,9 The current Australian guidelines 10 recommend follow-up for detection of recurrence at risk-adjusted intervals of 10 years for patients with melanoma stage I or IIA. The guidelines also recommend that patients should be made aware of their risk of developing further primary melanomas and consider lifelong skin surveillance.…”