Search

Efforts were made to further explain female superiority in survival of 753 patients with clinical Stage I malignant melanoma. Two factors contributing to this female superiority in survival drew some of their prognostic value from the correlation with tumor thickness. (1) More than twice as many women as men had primary lesions located on the extremities, which were prognostically favorable anatomical sites in both men and women. In addition, women with extremity lesions had a more favorable prognosis than men with extremity lesions. This sex differential in survival for patients with extremity lesions was partly attributable to the fact that the extremity lesions of women were significantly thinner than those of men. (2) Significantly more women than men were under age 50; this age group of women had a significantly better prognosis than the corresponding age group of men. The sex differential in survival for patients under 50 years was partly attributable to the fact that the women's lesions were significantly thinner than those of men. There was only a slight sex differential in the survival of patients 50 years and over, a finding in consonance with the smaller difference in tumor thickness between these older men and women. The association between decline in prognosis with increasing age and decline in proportion of thin lesions with increasing age was much closer in men than women. In men and women matched by age, site, and thickness of primary lesions, women with very thick tumors still survived longer.

A study was made of 326 patients first treated for clinical stage I cutaneous malignant melanoma by a wide excision (with or without split-skin graft) but no nodal dissection and who subsequently developed recurrence of their disease. Thick lesions recurred far more frequently than very thin lesions, although evidence of partial regression in very thin lesions conferred upon the latter a liability to metastasize. Thicker lesions first recurred predominantly in the vicinity of the scar of primary lesion excision whilst very thin lesions first recurred either at regional lymph nodes or at remote sites. The disease-free interval fell with increasing tumour thickness. As a result of this, local first recurrences developed more rapidly than remote first recurrences. The cumulative 10-year survival rate for patients with local first recurrences was, however, significantly higher than for patients with remote first recurrences, as the survival period after local first recurrence was considerably longer than after remote first recurrence. We conclude that tumour thickness is an easily measured, objective predictor of the site and time of first recurrence from melanoma. Thus, by facilitating early detection of first metastases, it may be possible to prolong survival time.

In Queensland and New South Wales, malignant melanoma is being diagnosed and treated at an earlier biological stage than in previous years. An analysis of 670 men treated since 1973 at Sydney Hospital indicated that recognition of and survival from melanoma varied according to occupation. Unskilled patients had a markedly worse prognosis than more skilled patients, a finding attributable, at least in part, to later presentation for treatment. We conclude that although public awareness of melanoma has increased due to continual publicity, the educational programme must be concentrated on the lower socioeconomic groups.

Five-year survival rates were similar in men and women with nodal metastases from malignant melanoma (clinical Stage II). This is in contrast to our previous studies on patients with localized disease (clinical Stage I) which indicated a marked female superiority in survival. To seek explanation for this, we examined in these patients with regional lymph node metastases, four factors which we previously showed to be of prognostic importance in patients with localized disease: (1) Age of patient: overall survival rate in Stage II women was markedly reduced due to extremely poor prognosis for postmenopausal women; (2) Site of primary lesion: Stage II women had a preponderance of extremity lesions, but these were not more prognostically favorable anatomic locations than axial locations; (3) Tumor thickness: women with metastatic malignant melanoma had a significantly higher proportion of very thick lesions than men; and (4) Evidence of tumor regression: although men with very thin regressing tumors had a poor prognosis, there were too few lesions of this thickness in patients with Stage II melanoma to markedly influence overall survival. It was concluded that although overall five-year survival rates in men and women with clinical Stage II malignant melanoma were similar, if these patients were matched by age and thickness of primary lesion, a female superiority in survival did exist for young patients with very thick tumors.