[Mortality of invasive malignant cutaneous melanoma. A review with special consideration of gender distribution]

Clinical epidemiology of invasive cutaneous malignant melanoma in the Austrian province Styria in the years 2001-2003 and its relationship with local geographical, meteorological and economic data

BACKGROUND

Melanoma incidence rates vary within Europe. The highest incidences are reported in Scandinavia, the lowest in the southern parts, but incidences themselves also vary within the different countries.

OBJECTIVE

We investigated the incidence of invasive cutaneous melanoma in Styria, a province of Austria, in the years 2001-2003.

METHODS

Data from 1,082 patients, 511 males and 571 females (mean age 58.2 years) with primary melanoma were collected. For each patient, information regarding residence was available, and therefore the geographic distribution of melanoma on district level was investigated with particular reference to the mean number of sun hours, mean altitude, number of companies with more than 200 employees and median income.

RESULTS

The mean annual incidence (age-standardized rate) was 24.5 per 100,000 (95% CI: 22.4-26.6), lifetime risk 1 in 52. Districts with a higher number of sun hours and higher altitude showed lower melanoma incidences. Higher median income was associated with higher melanoma incidence (p<0.001).

CONCLUSION

The high incidence of invasive melanoma in Styria is unclear and a causal relationship between higher income and melanoma incidence remains speculative. Further investigations, especially concerning lifestyle and environmental factors, may unravel additional causative factors.

Natural history of invasive cutaneous melanoma in Styria, Austria 2001?2003

BACKGROUND

Rising melanoma incidences have created the need of assessment of epidemiological and clinical data.

PATIENTS AND METHODS

We investigated the natural history of invasive cutaneous melanoma in Styria, a province of Austria, in the years 2001-2003. 1082 patients, 511 men and 571 women, mean age 58.2 +/- 16.7 years, were collected. Besides basic melanoma data, special histologic features such as regression structures, ulceration, microsatellites and vascular invasion were investigated. Furthermore, lymph node pathology in case of sentinel node biopsy and/or lymph node dissection was recorded.

RESULTS

Mean annual incidence (crude rate) was 28.6 per 100,000 inhabitants, age standardized rate 24.5 per 100,000 (95 % CI 22.4-26.6). Cumulative risk (0- 74 years) was 1.92, lifetime risk 1 in 52. Superficial spreading melanoma was the most common type in both sexes, men on the trunk and women on the extremities. Only 11 % of all melanomas were in easily visible areas. Median tumor thickness was 0.75 mm, ranging between 0.2 and 50.0 mm. Sentinel node biopsy was performed in 158 melanomas (14.6 %),and was positive in 22 %.Primary therapeutic lymph node dissection was performed in 19 patients, showing metastases in 18 patients.

CONCLUSIONS

The investigation revealed an unclear high melanoma incidence for invasive melanomas in our province, requiring further investigation.

Prospective, Randomized, Multicenter, Double-Blind Placebo-Controlled Trial Comparing Adjuvant Interferon Alfa and Isotretinoin With Interferon Alfa Alone in Stage IIA and IIB Melanoma: European Cooperative Adjuvant Melanoma Treatment Study Group

Purpose

The combination of interferon alfa (IFNα) and isotretinoin has shown a direct antiproliferative effect on human melanoma cell lines, but it remained unclear whether this combination is more effective than IFNα alone in patients with metastatic melanoma. We evaluated safety and efficacy of IFNα and isotretinoin compared with IFNα alone as adjuvant treatment in patients with primary malignant melanoma stage IIA and IIB.

Patients and Methods

In a prospective, randomized, double-blind, placebo-controlled trial, 407 melanoma patients in stage IIA (301 patients) and IIB (106 patients) were randomly assigned to either IFNα and isotretinoin (isotretinoin group; 206 patients) or IFNα and placebo (placebo group; 201 patients) after excision of the primary tumor. IFNα was administered three times a week at a dose of 3 million units subcutaneously for 24 months. Isotretinoin at a dose of 20 mg for patients ≤ 73 kg, 30 mg for patients greater than 73 kg, or placebo daily for 24 months.

Results

A scheduled interim analysis revealed no significant differences in survival rates, with the isotretinoin group and the placebo group showing 5-year disease-free survival rates of 55% (95% CI, 46% to 65%) and 67% (95% CI, 59% to 75%), respectively, and overall 5-year survival rates of 76% (95% CI, 67% to 84%) and 81% (95% CI, 74% to 88%), respectively. The trial was stopped for futility.

Conclusion

The addition of isotretinoin to an adjuvant treatment of low-dose IFNα in patients with stage IIA and IIB melanoma had no significant effect on disease-free or overall survival and is therefore not recommended.

Calculated tumour volume as a prognostic parameter for survival in choroidal melanomas

PURPOSE

Tumour diameter, tumour height, and tumour volume are considered important prognostic indicators of survival in choroidal melanomas. In this study, we investigated the prognostic impact on survival of the easily calculated volume estimate based on the assumption of a half-rotation ellipsoid.

METHODS

The largest tumour diameter and tumour height were measured by ultrasound A- and B-scan in 93 patients with choroidal melanoma. Tumour volume was calculated by the half volume of a rotation ellipsoid formula, rotated around the y-axis, and compared to tumour diameter and tumour height. All parameters were correlated to the clinical outcome of the patients.

RESULTS

At the time of diagnosis, the mean diameter was 10.4 mm (range 4.1-18.9 mm), and the mean height was 5.7 mm (range 1.74-14.9 mm). The range of the calculated tumour volume was between 11 and 628 mm(3) (mean volume 190 mm(3)). Among all patients, distant metastases occurred in 10 patients (10.8%). In a univariate approach using Mantel-Haenszel log-rank test, the calculated tumour volume at the time of diagnosis was the best prognostic indicator of survival followed by tumour diameter and tumour height (P=0.028). When tumour volume, horizontal and vertical tumour diameter, age, sex, and primary tumour therapy were considered in a multivariate approach using Cox proportional Hazard model, only tumour volume turned out as a significant prognostic parameter (P=0.001).

CONCLUSIONS

Calculated tumour volume is a better prognostic indicator of survival of patients with choroidal melanomas than the largest tumour diameter and tumour height, and might be established in daily routine.