Melanoma: Women Have Survival Advantage

Susan Swetter, MD Professor of Dermatology Director, Pigmented Lesion & Melanoma Program Stanford University Medical Center & Cancer InstituteMedicalResearch.com Interview with: Susan Swetter, MD
Professor of Dermatology
Director, Pigmented Lesion & Melanoma Program
Stanford University Medical Center & Cancer Institute

 

Melanoma Survival Disadvantage in Young, Non-Hispanic White Males Compared With Females

MedicalResearch.com: What are the main findings of the study?

Dr. Swetter: Women diagnosed with melanoma tend to fare better than men in terms of improved survival, and this has mostly been attributed to better screening practices and behaviors in women that result in thinner, more curable tumors, and/or more frequent physician visits in older individuals that result in earlier detection.  Our study focused on survival differences between young men and women (ages 15-39 years) diagnosed with cutaneous (skin) melanoma, who constitute a generally healthy population compared to the older adults that have usually been studied. We found that young men were 55% more likely to die of melanoma than age-matched women, despite adjustment for factors that may affect prognosis, such as tumor thickness, histology and location of the melanoma, as well as presence and extent of metastasis. Our results present further evidence that a biologic mechanism may contribute to the sex disparity in melanoma survival, since adolescent and young adults see physicians less frequently and are less likely to have sex-related behavior differences in skin cancer screening practices than older individuals.

MedicalResearch.com: Were any of the findings unexpected?

Dr. Swetter:  We did not expect to see such marked survival differences in adolescent and young adults (AYA) men with melanoma compared with AYA women, even when we adjusted for other prognostic factors. Our findings are timely, as a 2012 pooled analysis of 4 European Organisation for Research and Treatment of Cancer (EORTC) phase III trials found that women with melanoma had a 30% survival advantage compared to men, despite similar clinical follow-up and treatment (Joosse et al. Superior outcome of women with stage I/II cutaneous melanoma:. J Clin Oncol 2012). In addition, a more recent European analysis demonstrated a persistent, independent female survival advantage even in patients with advanced melanoma, though most patients in these studies tended to be older. These studies, and ours, suggest that biology may play a bigger role than behavior in terms of sex differences in survival.

MedicalResearch.com: What should clinicians and patients take away from your report?

Dr. Swetter: Our results present further evidence that a biologic mechanism may contribute to the sex disparity in melanoma survival, particularly since adolescent and young adults see physicians less frequently and are less likely to have sex-related behavior differences in skin cancer screening practices than older individuals.  Key messages for physicians to impart to patients are as follows:

1) Use sunscreen and practice sun protective behaviors whenever possible, especially since a prospective, randomized trial in Australia demonstrated reduced incidence of melanoma in regular sunscreen users compared to discretionary sunscreen users (Greene et al 2010).

2) Avoid tanning beds and seeking a tan at all costs – they are bad for you.

3) Even though you are young and your skin cancer/melanoma risks are lower than those of adults over age 50, see a health care provider promptly for any changing moles or skin lesions that look different from the rest.  It may end up being a harmless finding, but early detection of melanoma could save your life.

Most recent public health messages have focused on primary prevention of melanoma in adolescent and young adult women through tanning bed avoidance. A similar message to adolescent and young adult men that emphasizes that they tend to do worse with melanoma may help to promote early detection of any new or changing skin lesion that may represent melanoma and enhance chances for cure.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Dr. Swetter: We really don’t understand the potential biologic differences that may account for our findings of worse melanoma survival in young men compared with women. Several theories for the survival disparity include differences in sex hormones, vitamin D metabolism, and immune regulation, but further investigation is needed to explore these proposed mechanisms.

Citation:

Gamba CS, Clarke CA, Keegan TM, Tao L, Swetter SM. Melanoma Survival Disadvantage in Young, Non-Hispanic White Males Compared With Females. JAMA Dermatol. 2013;():1-8. doi:10.1001/jamadermatol.2013.4408.

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