High mortality due to cutaneous melanoma in Norway: a study of prognostic factors in a nationwide cancer registry

Abstract

PurposeThe purpose of this study was to examine why Norway has the highest rate of mortality due to cutaneous melanoma (CM) in Europe. The Norwegian Malignant Melanoma Registry (NMMR) enables the study of clinical and histopathological characteristics of patients who die due to CM.ResultsThe NMMR and the Norwegian Cause of Death Registry provided data on the clinical and histopathological factors as well as the date and cause of death, through June 2015 for all first invasive CMs diagnosed in 2008–2012 (n=8087). Cox regression was used to estimate associations between clinical and pathological factors and CM-specific death. Multiple imputation was used to handle missing data.ResultsThe CMs were equally distributed between men (49.9%) and women (50.1%), and the median follow-up was 4.0 years (range: 0.08–7.5 years). Trunk was the most common anatomic site (48%), superficial spreading melanoma was the dominant melanoma subtype (68.2%), median Breslow thickness was 1.0 mm, ulceration was present in 23% of CMs, and 91.8% of cases were in a local clinical stage at diagnosis. Compared to women, men were diagnosed at a higher age, with thicker and more-often-ulcerated tumor, and more often were in advanced clinical stages. During follow-up, 1015 patients died due to CM, representing 52.8% of all deaths. The nodular subtype made up the dominant proportion of fatal CM cases (55.3% in women, 64.6% in men). Sex, age, anatomic site (trunk), T-stage, ulceration, clinical stage, and having a second primary CM were associated with increased risk of CM-specific death.ConclusionOur data suggest that the high rate of mortality due to CM observed in Norway is attributable to the more advanced stage of the disease at diagnosis. Most high-risk cases occurred in male patients ≥70 years of age. Efforts to improve awareness and secondary prevention of CM, including warning signs of all melanoma subtypes, are required urgently and should be targeted toward men in particular.

Anthropometric factors and Breslow thickness: prospective data on 2570 cases of cutaneous melanoma in the population-based Janus Cohort

“…The proportions of men diagnosed as T3/T4 were around twice that of women. That men are diagnosed with CM at a later stage than women has also been reported in two recent Norwegian studies, and may be a result of lower awareness (patient delay) or a higher tumour growth rate in men . Our finding that 24% of the cases were diagnosed as T3/T4 is in sharp contrast to the 15% reported from the U.S.A. and Australia .…”

Improved melanoma outcomes and survival in patients monitored by total body photography: A natural experiment

“…In addition to lack of follow‐up visits, increasing age and male sex were predictors of worse overall survival. The likelihood of death due to any cause increases with age, and male sex is a reported risk factor for death in patients with history of melanoma . Our cohort was typical of others described in the published work who have undergone TBP, in terms of age distribution and female predominance .…”

“…The likelihood of death due to any cause increases with age, and male sex is a reported risk factor for death in patients with history of melanoma. 13,14 Our cohort was typical of others described in the published work who have undergone TBP, in terms of age distribution and female predominance. 15,16 The association of more than 100 nevi with greater overall survival is consistent with a recent report demonstrating that melanomas in patients with low nevus counts are more likely to have unfavorable histological features.…”

Association between tumor characteristics and second primary cancers with cutaneous melanoma survival: A nationwide cohort study

“…Of note, as we wanted to see the effects from SPC diagnosis, the present data included all deaths while some survival literature covers melanoma‐specific survival. For example, a recent Norwegian study on melanoma‐specific survival reported a HR of 16.82 for distant metastases and 9.68 for T4 class; the follow‐up time was short from 2008 to 2015 which additionally emphasizes the role of metastases at diagnosis (Robsahm et al, ). While that study and a few others have considered survival in patients with second melanoma, our study is probably the only one so far considering other SPCs in the multivariable models (Utjes et al, ).…”

“…Survival is critically dependent on whether the tumor is localized (96%), or spread to distant sites (41%), according to a US study, but even for thick localized tumors survival is decreased (Lo, Scolyer, & Thompson, ; Pollack et al, ). The reasons for the positive development are not entirely clear but tumor thickness is strongly related to survival and the overall tumor thickness has generally decreased in the United States and parts of Europe (Lyth et al, ; Robsahm et al, ; Shaikh et al, ). However, there are indications that the positive trend in survival has stalled in the United States and Sweden, suggesting the importance of novel strategies for early diagnosis (Jemal et al, ; Lyth et al, ).…”