0.8 mm el grosor para sobrevida a 20 años en Melanoma...

Thicker Melanoma Tumor Size Tied to Higher Risk of 20-Year Melanoma-Related Death

Findings for primary tumors of 0.8 to 1.0 mm versus those <0.8 mm

HealthDay

FRIDAY, Dec. 13, 2024 (HealthDay News) -- Risk of 20-year melanoma-related death increases significantly for patients with primary tumors of 0.8 to 1.0 mm in thickness, according to a study published online Dec. 11 in JAMA Dermatology.

Serigne N. Lo, Ph.D., from the University of Sydney, and colleagues assessed the relative effect of a 0.8-mm Breslow thickness threshold with respect to the incidence of both melanoma-related and nonmelanoma-related death. Analysis included registry data for 144,447 individuals diagnosed with thin invasive primary melanomas between 1982 and 2014.

The researchers found that crude incidence rates of melanoma-related death 20 years after diagnosis were 6.3 percent for the whole cohort, 6.0 percent for tumors <0.8 mm, and 12.0 percent for tumors 0.8 to 1.0 mm. The corresponding 20-year melanoma-specific survival rates were 91.9 percent overall and 94.2 and 87.8 percent, respectively, across tumor sizes. Tumor thickness of 0.8 to 1.0 mm was significantly associated with both a greater absolute risk of melanoma-related death (subdistribution hazard ratio, 2.92), as well as a greater rate of melanoma-related death (hazard ratio, 2.98), compared to thinner tumors (<0.8 mm). There was no association seen between risk of death from nonmelanoma-related causes and Breslow thickness.

"The findings of this large-scale population-based analysis suggest the separation of risk for patients with melanomas with a Breslow thickness above and below 0.8 mm," the authors write.

Several authors disclosed ties to the pharmaceutical industry.

Original Investigation 

December 11, 2024

Risk of Death Due to Melanoma and Other Causes in Patients With Thin Cutaneous Melanomas

Serigne N. Lo, PhD^1,2,3; Gabrielle J. Williams, PhD^1,2; Anne E. Cust, PhD^1,4; et al David W. Ollila, MD^5,6; Alexander H. R. Varey, MBChB, PhD^1,2,7; Sydney Ch'ng, MD, PhD^1,2,8; Richard A. Scolyer, MD^1,2,3,9; John F. Thompson, MD^1,2,8,10

Author Affiliations

JAMA Dermatol. Published online December 11, 2024. doi:10.1001/jamadermatol.2024.4900

Full Text

Key Points

Question  What is the relative effect of a 0.8-mm thickness threshold on melanoma-related and nonmelanoma-related death in patients with thin melanomas (Breslow thickness ≤1.0 mm)?

Findings  In this cohort study of 144 447 participants, patients with melanomas 0.8-mm to 1.0-mm thick had a significantly greater risk of melanoma-related death than patients with melanomas smaller than 0.8 mm.

Meaning  In this study, there was a separation in risk of melanoma-related death for patients with melanomas above and below the 0.8-mm Breslow thickness.

Abstract

Importance  Most patients who present with primary cutaneous melanomas have thin tumors (≤1.0 mm in Breslow thickness, ie, pT1a and pT1b). Although their prognosis is generally considered to be excellent, there is limited precise information on the association of risk of death with specific Breslow measurements in thin lesions.

Objective  To assess the relative effect of a 0.8-mm Breslow thickness threshold with respect to the incidence of both melanoma-related and nonmelanoma-related death.

Design, Setting, and Participants  Registry data for all Australians diagnosed with thin invasive primary melanomas between 1982 and 2014 were analyzed. Data were extracted from all 8 Australian state and territory population-based cancer registries. Dates and causes of death were obtained from the Australian National Death Index. Adults diagnosed with a first invasive primary melanoma of 1.0 mm or smaller in thickness were included.

Exposure  First invasive primary melanoma between 1982 and 2014.

Main Outcomes and Measures  The primary outcomes were melanoma-related deaths and nonmelanoma-related deaths. Competing-risk regression analyses and cause-specific analyses were performed to investigate the relationships between Breslow thickness subcategory (<0.8 mm versus ≥0.8 mm by 0.1-mm increments) and the primary outcomes.

Results  Overall, a cohort of 144 447 participants was included. The median (range) age was 56 (18-101) years and 78 014 (54.0%) were men. Median (IQR) follow-up was 15.0 (9.5-23.3) years. Crude incidence rates of melanoma-related death 20 years after diagnosis were 6.3% (95% CI, 6.1%-6.5%) for the whole cohort, 6.0% (95% CI, 5.7%-6.2%) for tumors smaller than 0.8 mm, and 12.0% (95% CI, 11.4%-12.6%) for tumors 0.8 to 1.0 mm. The corresponding 20-year melanoma-specific survival rates were 91.9% (95% CI, 91.6%-92.1%), 94.2% (95% CI, 94.0%-94.4%), and 87.8% (95% CI, 87.3%-88.3%), respectively. On multivariable analysis, tumor thickness of 0.8 to 1.0 mm was significantly associated with both a greater absolute risk of melanoma-related death (subdistribution hazard ratio, 2.92; 95% CI, 2.74-3.12) and a greater rate of melanoma-related death (hazard ratio, 2.98; 95% CI, 2.79-3.18) than thinner tumors (<0.8 mm). Risk of death from nonmelanoma-related causes was not associated with Breslow thickness.

Conclusions and Relevance  In this study, the risk of melanoma-related death increased significantly for patients with primary tumors of 0.8 to 1.0 mm in thickness. The risk of death from nonmelanoma-ralated causes was similar across Breslow thicknesses of 0.1 to 1.0 mm. This analysis suggests that a 0.8-mm threshold for guiding the care of patients with thin primary melanomas.