Melanoma More Deadly in Young Men
Published: Jun 26, 2013 | Updated: Jun 27, 2013
By Charlene Laino, Senior Writer, Gupta Guide
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN,
Young men with melanoma were 55% more likely to die than their female counterparts, according to a population-based study with up to 20 years of follow-up.
Note that the reason for the worse survival among young men is not known, but evidence supports a biologic explanation.
Young men with melanoma were 55% more likely to die than their female counterparts, according to a population-based study with up to 20 years of follow-up.
Men ages 15 to 39 accounted for only 39.8% of melanoma cases among some 26,000 in the study population, they comprised 63.6% of deaths due to the disease, Christina S. Gamba, MD, of Stanford University Medical Center, and colleagues reported online in JAMA Dermatology.
“This alarming difference highlights the urgent need for both behavioral interventions to promote early detection strategies in young men and further investigation of the biological basis for the sex disparity in melanoma survival,” the researchers wrote.
Prior research in the U.S. and worldwide has shown that women with melanoma have a consistent survival advantage over men, but the study populations were predominantly composed of middle-aged and older adults.
But understanding melanoma in younger people is crucial, Gamba and colleagues said, particularly since it is the third most common cancer in the 15 to 39 age group and accounts for more years-of-potential-life lost than any other tumor.
So they turned to the Surveillance, Epidemiology, and End Results (SEER) database and identified 26,107 non-Hispanic white adolescents and young adults with a primary invasive melanoma of the skin diagnosed from January 1989 through December 2009.
The mean follow-up was 7.5 years, during which time 1,561 melanoma-specific deaths were reported among the study population.
After adjustment for tumor thickness, histologic subtype, presence and extent of metastasis, and anatomical location, young men were significantly more likely to die than young females (HR=1.55, 95% CI, 1.39-1.73).
Subgroup analysis showed men were more likely to die within each age range assessed — that is, ages 15 to 24, 25 to 29, 30 to 34, and 35 to 39.
Moreover, even young men with thin melanomas of 1 mm or less were nearly twice as likely to die as age-matched females (HR=1.95; 95% CI, 1.57-2.42).
Adjustment for health insurance and socioeconomic status in a subanalysis did not significantly alter the results.
The big questions, of course, are why and what can be done.
Overall, the results support a biologic explanation for the male survival disadvantage, the researchers said. For starters, young men with thinner melanomas were more likely to die than their female counterparts. Second, they were 67% more likely to die of lower extremity melanomas – which normally have a more favorable outcome than those located elsewhere — than females, even after adjusting for tumor thickness.
Also, studies have shown that fewer than 10% of melanomas in younger people are discovered by physicians, with most found by the patients themselves. That point alone argues against better screening as the major explanation for the mortality gap, they said.
In an accompanying editorial, David E. Fisher, MD, PhD, of Harvard Medical School, and Alan C. Geller, MPH, RN, of the Harvard School of Public Health, made an even stronger case for a biological basis of the female survival advantage.
“The findings are so consistent that they imply a fundamental biological difference in ‘male’ versus ‘female’ melanoma, at least for a significant fraction of patients,” they wrote.
Noting that young men are far less likely than young women to see primary care physicians trained to provide preventive screenings and counseling, Fisher and Geller said that discovering earliest-stage melanoma in young men will have its challenges.
“However, a three-fold strategy of awareness raising, more opportunities for screening, and incentives to screen should be implemented,” they said.
“Hopefully, studies such as the one reported herein can prompt primary care physicians of young at-risk men to carefully screen their patients and counsel them to perform monthly skin self-examinations,” they said.
The study has several limitations, including that two important factors involved in melanoma prognosis — ulceration and mitosis — were variably reported to SEER and so could not be included as confounders in the analysis
Do you screen your young male patients for skin lesions and other signs of melanoma? Add Your Knowledge below. — Sanjay Gupta, MD