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Prognostic subclassifications of T1 cutaneous melanomas based on ulceration, tumour thickness and Clark’s level of invasion: results of a population-based study from the Swedish Melanoma Register
Linköping University, Department of Clinical and Experimental Medicine, Oncology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Health and Developmental Care, Regional Cancer Center South East Sweden.
Department of Oncology–Pathology, Karolinska Institute, Stockholm, Sweden.
Department of Surgery, Lund University Hospital, Lund, Sweden.
Department of Oncology–Pathology, Karolinska Institute, Stockholm, Sweden.
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2013 (English)In: British Journal of Dermatology, ISSN 0007-0963, E-ISSN 1365-2133, Vol. 168, no 4, 779-786 p.Article in journal (Refereed) Published
Abstract [en]

Background  Survival and prognostic factors for thin melanomas have been studied relatively little in population-based settings. This patient group accounts for the majority of melanomas diagnosed in western countries today, and better prognostic information is needed.

Objectives  The aim of this study was to use established prognostic factors such as ulceration, tumour thickness and Clark’s level of invasion for risk stratification of T1 cutaneous melanoma.

Methods  From 1990 to 2008, the Swedish Melanoma Register included 97% of all melanomas diagnosed in Sweden. Altogether, 13 026 patients with T1 melanomas in clinical stage I were used for estimating melanoma-specific 10- and 15-year mortality rates. The Cox regression model was used for further survival analysis on 11 165 patients with complete data.

Results  Ulceration, tumour thickness and Clark’s level of invasion all showed significant, independent, long-term prognostic information. By combining these factors the patients could be subdivided into three risk groups: a low-risk group (67·9% of T1 cases) with a 10-year melanoma-specific mortality rate of 1·5% (1·2–1·9%); an intermediate-risk group (28·6% of T1 cases) with a 10-year mortality rate of 6·1% (5·0–7·3%); and a high-risk group (3·5% of T1 cases) with a 10-year mortality rate of 15·6% (11·2–21·4%). The high- and intermediate-risk groups accounted for 66% of melanoma deaths within T1.

Conclusions  Using a population-based melanoma register, and combining ulceration, tumour thickness and Clark’s level of invasion, three distinct prognostic subgroups were identified.

Place, publisher, year, edition, pages
Wiley-Blackwell , 2013. Vol. 168, no 4, 779-786 p.
National Category
Medical and Health Sciences
URN: urn:nbn:se:liu:diva-92611DOI: 10.1111/bjd.12095ISI: 000317016100030PubMedID: 23066913OAI: diva2:621696

Funding Agencies|regional cancer centre Southeast in Linkoping||

Available from: 2013-05-16 Created: 2013-05-14 Last updated: 2015-01-28
In thesis
1. Clinical-epidemiological studies on cutaneous malignant melanoma: A register approach
Open this publication in new window or tab >>Clinical-epidemiological studies on cutaneous malignant melanoma: A register approach
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The incidence of cutaneous malignant melanoma (CMM) is steadily increasing. Most of the patients have thin CMM with a good prognosis and a 5-year survival of about 90%. The prognosis is highly related to tumour thickness and clinical stage at diagnosis. Effective systemic treatment for patients with metastatic disease has only recently been available. This thesis aims to increase knowledge of trends in tumour thickness, prognostic factors, socioeconomic differences and medical costs in patients with CMM.

The population-based Swedish melanoma register is the main source of data in all papers in the thesis. Papers I-III include patients from all of Sweden while paper IV is delimited to the County of Östergötland. Cox regression and logistic regression are the main multivariable methods used. Paper IV is focused on stage-specific costs of CMM by comparing direct healthcare costs to a general population.

For men, there has been a shift over time towards thinner tumours at diagnosis accompanied by an improved survival. Women are still diagnosed with considerably thinner tumours and they experience a better survival than men. Tumour ulceration, tumour thickness and Clark’s level of invasion all showed significant independent long-term prognostic information in T1 CMMs. By combining these factors, three distinct prognostic subgroups were identified. Lower level of education was associated with reduced CMM-specific survival, which may at least partially be attributed to a more advanced stage at diagnosis. The direct healthcare costs for CMM patients were significantly higher than for the general population, independent of clinical stage. CMM patients diagnosed in clinical stage III-IV were associated with particularly high costs.

Even though the survival among Swedish patients with CMM is among the highest in the world and still seems to improve, the results of this thesis emphasise the need of improved early detection strategies. This may be of particular concern in men, older women, and groups with a low level of education. The results also imply that the costs for the management of CMM patients may be reduced if early detection efforts are successful and lead to a more favourable stage distribution. The finding of a better risk stratification of thin CMMs may help to improve the management of this large patient group.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2015. 51 p.
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1428
Melanoma, early detection, population-based, registers, time trends, survival, prognostic factors, tumour thickness, stage at diagnosis, level of education, socioeconomic status, healthcare costs
National Category
Dermatology and Venereal Diseases Public Health, Global Health, Social Medicine and Epidemiology
urn:nbn:se:liu:diva-113145 (URN)10.3384/diss.diva-113145 (DOI)978-91-7519-191-1 (print) (ISBN)
Public defence
2015-02-13, Eken, ingång 65, Campus US, Linköpings Universitet, Linköping, 09:00 (Swedish)
Available from: 2015-01-28 Created: 2015-01-12 Last updated: 2016-04-01Bibliographically approved

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