The progressive relationship between increasing Breslow thickness and decreasing survival is lost in patients with ultrathick melanomas (≥15 mm in thickness)

Mary-Ann El Sharouni; Robert V Rawson; Vigfús Sigurdsson; Arjen J Witkamp; Carla H van Gils; Richard A Scolyer; John F Thompson; Paul J van Diest; Serigne N Lo

doi:10.1016/j.jaad.2022.01.040

The progressive relationship between increasing Breslow thickness and decreasing survival is lost in patients with ultrathick melanomas (≥15 mm in thickness)

J Am Acad Dermatol. 2022 Aug;87(2):298-305. doi: 10.1016/j.jaad.2022.01.040. Epub 2022 Feb 1.

Authors

Mary-Ann El Sharouni¹, Robert V Rawson², Vigfús Sigurdsson³, Arjen J Witkamp⁴, Carla H van Gils⁵, Richard A Scolyer⁶, John F Thompson⁷, Paul J van Diest⁸, Serigne N Lo⁹

Affiliations

¹ Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia; Department of Dermatology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
² Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia; Department of Tissue Oncology and Diagnostic Pathology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia; NSW Health Pathology, Sydney, New South Wales, Australia.
³ Department of Dermatology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
⁴ Department of Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
⁵ Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
⁶ Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia; Department of Tissue Oncology and Diagnostic Pathology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia; NSW Health Pathology, Sydney, New South Wales, Australia; Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, New South Wales, Australia.
⁷ Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia; Department of Pathology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands. Electronic address: john.thompson@melanoma.org.au.
⁸ Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia.
⁹ Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.

PMID: 35121073
DOI: 10.1016/j.jaad.2022.01.040

Abstract

Background: Survival tends to decrease as the Breslow thickness of a primary melanoma increases. However, little is known about the prognostic value of Breslow thickness in patients with very thick melanomas.

Objective: We sought to assess survival in patients with melanomas ≥4.0 mm in Breslow thickness.

Methods: A pooled cohort of 5595 patients (4107 Dutch and 1488 Australian) with melanomas ≥4.0 mm in thickness diagnosed from 2000 to 2014 was analyzed. Standard and spline Cox regressions were generated for overall survival (OS) and recurrence-free survival (RFS).

Results: The median follow-up was 3.4 years. The continuous hazard ratios (HRs) for OS and RFS increased steadily as the Breslow thickness increased to 15 mm, stabilized up to 20 mm, and decreased thereafter. Using patients with melanomas 4 to <10 mm thick as a reference group, the categoric HR for OS increased up to the 15- to -<20-mm thickness category and then decreased (HR, 1.46 [95% CI, 1.29-1.66], P < .0001 for 10-<15 mm; HR, 1.97 [95% CI, 1.55-2.51], P < .0001 for 15-<20 mm; and HR, 1.36 [95% CI, 1.07-1.84], P = .045 for ≥20 mm). For the RFS, similar trends were observed.

Limitations: Retrospective study. Small cohorts of patients with melanomas 15-<20mm and ≥20mm.

Conclusion: The progressive relationship between increasing Breslow thickness and decreasing survival is lost in patients with melanomas ≥15 mm in thickness.

Keywords: Breslow thickness; epidemiology; melanoma; prognosis; survival.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Australia / epidemiology
Humans
Melanoma* / pathology
Neoplasm Staging
Prognosis
Retrospective Studies
Sentinel Lymph Node Biopsy
Skin Neoplasms* / pathology