De Novo vs Nevus-Associated Melanomas: Differences in Associations With Prognostic Indicators and Survival

Rachel M. Cymerman, Yongzhao Shao, Kun Wang, Yilong Zhang, Era C. Murzaku, Lauren A. Penn, Iman Osman, David Polsky

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Background: Although 20% to 30% of melanomas are histopathologically 'nevus associated,' the majority of melanomas arise de novo, ie, in clinically normal skin with no associated nevus. We examined whether these forms of melanoma differed in their associations with clinical and histopathologic features and patient survival. Methods: We analyzed two prospective cohorts from our institution with protocol-driven follow-up information (NYU1, n = 1024; NYU2, n = 1125). We used univariate and multivariable analyses to examine associations between de novo vs nevus-associated melanoma classification and age, anatomic site, tumor thickness, tumor ulceration, mitotic index, histological subtype, clinical stage, and survival. We tested the associations identified in NYU1 using NYU2 as a replication cohort. All tests of statistical significance were two-sided. Results: In NYU1, de novo melanomas were associated with tumor thickness greater than 1.0 mm (odds ratio [OR] = 1.96, 95% confidence interval [CI] = 1.43 to 2.70, P <. 001), ulceration (OR = 1.65, 95% CI = 1.10 to 2.54, P =. 02), nodular subtype (OR = 3.26, 95% CI = 1.70 to 7.11, P =. 001), greater than stage I (OR = 2.35, 95% CI = 1.65 to 3.40, P <. 001), older age (OR = 1.64, 95% CI = 1.18 to 2.30, P =. 004), and shorter overall survival (HR = 1.63, 95% CI = 1.22 to 2.18, P <. 001). In NYU2, de novo melanoma was again statistically significantly associated with thickness greater than 1.0 mm (OR = 2.24, 95% CI = 1.72 to 2.93, P <. 001), ulceration (OR = 2.88, 95% CI = 1.95 to 4.37, P <. 001), nodular subtype (OR = 2.41, 95% CI = 1.75 to 3.37, P <. 001), greater than stage I (OR = 2.42, 95% CI = 1.80 to 3.29, P <. 001), older age (OR = 1.68, 95% CI = 1.31 to 2.17, P <. 001), and shorter overall survival (HR = 2.52, 95% CI = 1.78 to 3.56, P <. 001). In multivariable analysis, de novo classification was an independent, poor prognostic indicator in NYU2 (HR = 1.70, 95% CI = 1.19 to 2.44, P =. 004). Male patients had a statistically significantly worse survival than female patients if their melanoma was de novo (NYU1, P <. 001; NYU2, P <. 001); unexpectedly, there was no sex difference in survival among patients with nevus-associated tumors. Conclusions: These data suggest that de novo melanomas are more aggressive than nevus-associated melanomas. This classification scheme may also provide a useful framework for investigations into sex differences in melanoma outcomes.

Original languageEnglish (US)
Article numberdjw121
JournalJournal of the National Cancer Institute
Volume108
Issue number10
DOIs
StatePublished - Oct 1 2016
Externally publishedYes

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Nevi and Melanomas
Confidence Intervals
Survival
Odds Ratio
Melanoma
Nevus
Sex Characteristics
Neoplasms
Mitotic Index

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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De Novo vs Nevus-Associated Melanomas : Differences in Associations With Prognostic Indicators and Survival. / Cymerman, Rachel M.; Shao, Yongzhao; Wang, Kun; Zhang, Yilong; Murzaku, Era C.; Penn, Lauren A.; Osman, Iman; Polsky, David.

In: Journal of the National Cancer Institute, Vol. 108, No. 10, djw121, 01.10.2016.

Research output: Contribution to journalArticle

Cymerman, Rachel M. ; Shao, Yongzhao ; Wang, Kun ; Zhang, Yilong ; Murzaku, Era C. ; Penn, Lauren A. ; Osman, Iman ; Polsky, David. / De Novo vs Nevus-Associated Melanomas : Differences in Associations With Prognostic Indicators and Survival. In: Journal of the National Cancer Institute. 2016 ; Vol. 108, No. 10.
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title = "De Novo vs Nevus-Associated Melanomas: Differences in Associations With Prognostic Indicators and Survival",
abstract = "Background: Although 20{\%} to 30{\%} of melanomas are histopathologically 'nevus associated,' the majority of melanomas arise de novo, ie, in clinically normal skin with no associated nevus. We examined whether these forms of melanoma differed in their associations with clinical and histopathologic features and patient survival. Methods: We analyzed two prospective cohorts from our institution with protocol-driven follow-up information (NYU1, n = 1024; NYU2, n = 1125). We used univariate and multivariable analyses to examine associations between de novo vs nevus-associated melanoma classification and age, anatomic site, tumor thickness, tumor ulceration, mitotic index, histological subtype, clinical stage, and survival. We tested the associations identified in NYU1 using NYU2 as a replication cohort. All tests of statistical significance were two-sided. Results: In NYU1, de novo melanomas were associated with tumor thickness greater than 1.0 mm (odds ratio [OR] = 1.96, 95{\%} confidence interval [CI] = 1.43 to 2.70, P <. 001), ulceration (OR = 1.65, 95{\%} CI = 1.10 to 2.54, P =. 02), nodular subtype (OR = 3.26, 95{\%} CI = 1.70 to 7.11, P =. 001), greater than stage I (OR = 2.35, 95{\%} CI = 1.65 to 3.40, P <. 001), older age (OR = 1.64, 95{\%} CI = 1.18 to 2.30, P =. 004), and shorter overall survival (HR = 1.63, 95{\%} CI = 1.22 to 2.18, P <. 001). In NYU2, de novo melanoma was again statistically significantly associated with thickness greater than 1.0 mm (OR = 2.24, 95{\%} CI = 1.72 to 2.93, P <. 001), ulceration (OR = 2.88, 95{\%} CI = 1.95 to 4.37, P <. 001), nodular subtype (OR = 2.41, 95{\%} CI = 1.75 to 3.37, P <. 001), greater than stage I (OR = 2.42, 95{\%} CI = 1.80 to 3.29, P <. 001), older age (OR = 1.68, 95{\%} CI = 1.31 to 2.17, P <. 001), and shorter overall survival (HR = 2.52, 95{\%} CI = 1.78 to 3.56, P <. 001). In multivariable analysis, de novo classification was an independent, poor prognostic indicator in NYU2 (HR = 1.70, 95{\%} CI = 1.19 to 2.44, P =. 004). Male patients had a statistically significantly worse survival than female patients if their melanoma was de novo (NYU1, P <. 001; NYU2, P <. 001); unexpectedly, there was no sex difference in survival among patients with nevus-associated tumors. Conclusions: These data suggest that de novo melanomas are more aggressive than nevus-associated melanomas. This classification scheme may also provide a useful framework for investigations into sex differences in melanoma outcomes.",
author = "Cymerman, {Rachel M.} and Yongzhao Shao and Kun Wang and Yilong Zhang and Murzaku, {Era C.} and Penn, {Lauren A.} and Iman Osman and David Polsky",
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TY - JOUR

T1 - De Novo vs Nevus-Associated Melanomas

T2 - Differences in Associations With Prognostic Indicators and Survival

AU - Cymerman, Rachel M.

AU - Shao, Yongzhao

AU - Wang, Kun

AU - Zhang, Yilong

AU - Murzaku, Era C.

AU - Penn, Lauren A.

AU - Osman, Iman

AU - Polsky, David

PY - 2016/10/1

Y1 - 2016/10/1

N2 - Background: Although 20% to 30% of melanomas are histopathologically 'nevus associated,' the majority of melanomas arise de novo, ie, in clinically normal skin with no associated nevus. We examined whether these forms of melanoma differed in their associations with clinical and histopathologic features and patient survival. Methods: We analyzed two prospective cohorts from our institution with protocol-driven follow-up information (NYU1, n = 1024; NYU2, n = 1125). We used univariate and multivariable analyses to examine associations between de novo vs nevus-associated melanoma classification and age, anatomic site, tumor thickness, tumor ulceration, mitotic index, histological subtype, clinical stage, and survival. We tested the associations identified in NYU1 using NYU2 as a replication cohort. All tests of statistical significance were two-sided. Results: In NYU1, de novo melanomas were associated with tumor thickness greater than 1.0 mm (odds ratio [OR] = 1.96, 95% confidence interval [CI] = 1.43 to 2.70, P <. 001), ulceration (OR = 1.65, 95% CI = 1.10 to 2.54, P =. 02), nodular subtype (OR = 3.26, 95% CI = 1.70 to 7.11, P =. 001), greater than stage I (OR = 2.35, 95% CI = 1.65 to 3.40, P <. 001), older age (OR = 1.64, 95% CI = 1.18 to 2.30, P =. 004), and shorter overall survival (HR = 1.63, 95% CI = 1.22 to 2.18, P <. 001). In NYU2, de novo melanoma was again statistically significantly associated with thickness greater than 1.0 mm (OR = 2.24, 95% CI = 1.72 to 2.93, P <. 001), ulceration (OR = 2.88, 95% CI = 1.95 to 4.37, P <. 001), nodular subtype (OR = 2.41, 95% CI = 1.75 to 3.37, P <. 001), greater than stage I (OR = 2.42, 95% CI = 1.80 to 3.29, P <. 001), older age (OR = 1.68, 95% CI = 1.31 to 2.17, P <. 001), and shorter overall survival (HR = 2.52, 95% CI = 1.78 to 3.56, P <. 001). In multivariable analysis, de novo classification was an independent, poor prognostic indicator in NYU2 (HR = 1.70, 95% CI = 1.19 to 2.44, P =. 004). Male patients had a statistically significantly worse survival than female patients if their melanoma was de novo (NYU1, P <. 001; NYU2, P <. 001); unexpectedly, there was no sex difference in survival among patients with nevus-associated tumors. Conclusions: These data suggest that de novo melanomas are more aggressive than nevus-associated melanomas. This classification scheme may also provide a useful framework for investigations into sex differences in melanoma outcomes.

AB - Background: Although 20% to 30% of melanomas are histopathologically 'nevus associated,' the majority of melanomas arise de novo, ie, in clinically normal skin with no associated nevus. We examined whether these forms of melanoma differed in their associations with clinical and histopathologic features and patient survival. Methods: We analyzed two prospective cohorts from our institution with protocol-driven follow-up information (NYU1, n = 1024; NYU2, n = 1125). We used univariate and multivariable analyses to examine associations between de novo vs nevus-associated melanoma classification and age, anatomic site, tumor thickness, tumor ulceration, mitotic index, histological subtype, clinical stage, and survival. We tested the associations identified in NYU1 using NYU2 as a replication cohort. All tests of statistical significance were two-sided. Results: In NYU1, de novo melanomas were associated with tumor thickness greater than 1.0 mm (odds ratio [OR] = 1.96, 95% confidence interval [CI] = 1.43 to 2.70, P <. 001), ulceration (OR = 1.65, 95% CI = 1.10 to 2.54, P =. 02), nodular subtype (OR = 3.26, 95% CI = 1.70 to 7.11, P =. 001), greater than stage I (OR = 2.35, 95% CI = 1.65 to 3.40, P <. 001), older age (OR = 1.64, 95% CI = 1.18 to 2.30, P =. 004), and shorter overall survival (HR = 1.63, 95% CI = 1.22 to 2.18, P <. 001). In NYU2, de novo melanoma was again statistically significantly associated with thickness greater than 1.0 mm (OR = 2.24, 95% CI = 1.72 to 2.93, P <. 001), ulceration (OR = 2.88, 95% CI = 1.95 to 4.37, P <. 001), nodular subtype (OR = 2.41, 95% CI = 1.75 to 3.37, P <. 001), greater than stage I (OR = 2.42, 95% CI = 1.80 to 3.29, P <. 001), older age (OR = 1.68, 95% CI = 1.31 to 2.17, P <. 001), and shorter overall survival (HR = 2.52, 95% CI = 1.78 to 3.56, P <. 001). In multivariable analysis, de novo classification was an independent, poor prognostic indicator in NYU2 (HR = 1.70, 95% CI = 1.19 to 2.44, P =. 004). Male patients had a statistically significantly worse survival than female patients if their melanoma was de novo (NYU1, P <. 001; NYU2, P <. 001); unexpectedly, there was no sex difference in survival among patients with nevus-associated tumors. Conclusions: These data suggest that de novo melanomas are more aggressive than nevus-associated melanomas. This classification scheme may also provide a useful framework for investigations into sex differences in melanoma outcomes.

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