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Social factors associated with very thick melanomas
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Factors related to patients’ sociodemographic characteristics and to the tumors contributed to the incidence of very thick melanomas, according to study results.
Researchers in France used a survey of cancer registries and questionnaires mailed to practitioners to study 898 melanomas diagnosed in 2008. One hundred forty-nine (16.6%) were very thick melanomas (VTM), with a Breslow thickness of 3 mm or greater (mean, 5.85 mm). Of the remaining melanomas, 149 were randomly selected for comparison (mean thickness, 0.88 mm).
In a general practice setting, VTMs were more often diagnosed than thinner melanomas (62% vs. 47.9%; P=.01). While dermatologists made correct diagnoses at first examination at a higher rate than general practitioners for both types of melanomas (77.1% vs. 47.7% for VTMs and 88.8% vs. 43.2% for thinner melanomas; P<.001), they had a lower diagnostic performance for VTMs than for thinner melanomas (77.1% vs. 88.8%; P=.01).
In multivariate logistic regression analysis, VTMs were more often located on the head and neck or lower limb (60.4% vs. 35.5%; P<.001), more frequently achromic (28.8% vs. 12.3%; P=.001), and had a higher proportion of acral lentiginous melanoma (ALM) and nodular melanoma (NM) (54.4% vs. 9.4%; P<.001) when compared with thinner tumors. Other factors associated with VTM compared with thinner melanomas included patients’ age (age 64 years vs. 55 years; P<.001), male sex (58.4% vs. 47.7%; P=.06), single, separated, divorced or widowed (35.8% vs. 23.5%; P=.03), living alone (31.9% vs. 19.0%; P=.01) and being less educated (73.4% vs. 60.3%). Older age, male sex and living alone were independent risk factors for VTM when factors related only to patients were examined, with solitary living the most significant risk (P=.001).
“The recognition of factors related to advanced-stage disease is the cornerstone of efforts to improve melanoma outcome,” the researchers concluded. “Future prevention programs should particularly focus on atypical/non-ABCD criteria [asymmetry, border irregularity, color variegation and diameter more than 6 mm] tumors, including ALM, NM and achromic melanoma … and target men, elderly people and patients living alone, regardless of their age.”
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