TY - JOUR
T1 - Ten-Year Survival after Multiple Invasive Melanomas Is Worse than after a Single Melanoma: a Population-Based Study
AU - Youlden, Danny R.
AU - Baade, Peter D.
AU - Soyer, H. Peter
AU - Youl, Philippa H.
AU - Kimlin, Michael G.
AU - Aitken, Joanne F.
AU - Green, Adele C.
AU - Khosrotehrani, Kiarash
N1 - Funding Information:
The authors would like to acknowledge the staff working in the Queensland Cancer Registry who provided us with the data extract used in this analysis. KK was supported by a National Health and Medical Research Council (NHMRC) Fellowship (#1023371), ACG was supported by a NHMRC Program Grant (#552429), and PHY was funded by a NHMRC Early Career Fellowship (#1054038).
Publisher Copyright:
© 2016 The Authors
PY - 2016/11/1
Y1 - 2016/11/1
N2 - The prognosis of melanoma patients who are diagnosed with multiple primary lesions remains controversial. We used a large population-based cohort to re-examine this issue, applying a delayed entry methodology to avoid survival bias. Of 32,238 eligible patients diagnosed between 1995 and 2008, 29,908 (93%) had a single invasive melanoma, 2,075 (6%) had two, and 255 (1%) had three. Allowing for differences in entry time, 10-year cause-specific survival for these three groups was 89% (95% confidence interval [CI] = 88–90%), 83% (95% CI = 80–86%), and 67% (95% CI = 54–81%), respectively. After adjustment for key prognostic factors, the hazard ratio of death within 10 years from melanoma was two times higher for those with two melanomas (hazard ratio = 2.01, 95% CI = 1.57–2.59; P < 0.001) and nearly three times higher when three melanomas were diagnosed (hazard ratio = 2.91, 95% CI = 1.64–5.18; P < 0.001) compared with people with a single melanoma. Melanoma-specific mortality remained elevated after adjusting for maximum thickness or ulceration of any melanoma regardless of the index tumor. After appropriately accounting for the interval between diagnosis of the first and subsequent melanomas, patients with multiple invasive melanomas have significantly poorer survival than patients with a single invasive melanoma.
AB - The prognosis of melanoma patients who are diagnosed with multiple primary lesions remains controversial. We used a large population-based cohort to re-examine this issue, applying a delayed entry methodology to avoid survival bias. Of 32,238 eligible patients diagnosed between 1995 and 2008, 29,908 (93%) had a single invasive melanoma, 2,075 (6%) had two, and 255 (1%) had three. Allowing for differences in entry time, 10-year cause-specific survival for these three groups was 89% (95% confidence interval [CI] = 88–90%), 83% (95% CI = 80–86%), and 67% (95% CI = 54–81%), respectively. After adjustment for key prognostic factors, the hazard ratio of death within 10 years from melanoma was two times higher for those with two melanomas (hazard ratio = 2.01, 95% CI = 1.57–2.59; P < 0.001) and nearly three times higher when three melanomas were diagnosed (hazard ratio = 2.91, 95% CI = 1.64–5.18; P < 0.001) compared with people with a single melanoma. Melanoma-specific mortality remained elevated after adjusting for maximum thickness or ulceration of any melanoma regardless of the index tumor. After appropriately accounting for the interval between diagnosis of the first and subsequent melanomas, patients with multiple invasive melanomas have significantly poorer survival than patients with a single invasive melanoma.
UR - http://www.scopus.com/inward/record.url?scp=84994779366&partnerID=8YFLogxK
U2 - 10.1016/j.jid.2016.03.014
DO - 10.1016/j.jid.2016.03.014
M3 - Article
C2 - 27019458
AN - SCOPUS:84994779366
SN - 0022-202X
VL - 136
SP - 2270
EP - 2276
JO - Journal of Investigative Dermatology
JF - Journal of Investigative Dermatology
IS - 11
ER -