JAMA Dermatology

<jats:sec id="ab-doi240056-4"><jats:title>Importance</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec id="ab-doi240056-5"><jats:title>Objective</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec id="ab-doi240056-6"><jats:title>Design, Setting, and Participants</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec id="ab-doi240056-7"><jats:title>Exposure</jats:title><jats:p>First invasive primary melanoma between 1982 and 2014.</jats:p></jats:sec><jats:sec id="ab-doi240056-8"><jats:title>Main Outcomes and Measures</jats:title><jats:p>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 (&amp;amp;lt;0.8 mm versus ≥0.8 mm by 0.1-mm increments) and the primary outcomes.</jats:p></jats:sec><jats:sec id="ab-doi240056-9"><jats:title>Results</jats:title><jats:p>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 (&amp;amp;lt;0.8 mm). Risk of death from nonmelanoma-related causes was not associated with Breslow thickness.</jats:p></jats:sec><jats:sec id="ab-doi240056-10"><jats:title>Conclusions and Relevance</jats:title><jats:p>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.</jats:p></jats:sec>

Update on thin melanoma: outcome of an international workshop.

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Global burden of cutaneous melanoma in 2020 and projections to 2040.

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Melanoma staging: Evidence-based changes in the American Joint Committee on Cancer eighth edition cancer staging manual.

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Melanoma survival is superior in females across all tumour stages but is influenced by age.

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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.

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Survival in 31?670 patients with thin melanomas–a Swedish population-based study.

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Mortality burden and prognosis of thin melanomas overall and by subcategory of thickness, SEER registry data, 1992-2013.

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Population-based 20-year survival among people diagnosed with thin melanomas in Queensland, Australia.

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Prognosis for patients with thin cutaneous melanoma: long-term survival data from New South Wales Central Cancer Registry and the Sydney Melanoma Unit.

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An analysis of risk factors for cutaneous melanoma by anatomical site (Australia).

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Clinicopathologic predictors of sentinel lymph node metastasis in thin melanoma.

Thickness, cross-sectional areas and depth of invasion in the prognosis of cutaneous melanoma.

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Long-term survival of patients with thin (T1) cutaneous melanomas: a Breslow thickness cut point of 0.8 mm separates higher-risk and lower-risk tumors.

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Choice and interpretation of statistical tests used when competing risks are present.

Introduction to the analysis of survival data in the presence of competing risks.

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Testing for causality and prognosis: etiological and prognostic models.

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The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies.

Lancet

Survival analysis part I: basic concepts and first analyses.

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Competing risk regression models for epidemiologic data.

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Checking Fine and Gray subdistribution hazards model with cumulative sums of residuals.

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BMC Cancer

Variability in cancer death certificate accuracy by characteristics of death certifiers.

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Prognosis for people with multiple primary melanomas compared with a single primary melanoma.

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.
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.
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.
First invasive primary melanoma between 1982 and 2014.
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.
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.
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.

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

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

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

Clinical Summary

What was studied

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