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 language | English (US) |
|---|---|
| Article number | djw121 |
| Journal | Journal of the National Cancer Institute |
| Volume | 108 |
| Issue number | 10 |
| DOIs | |
| State | Published - Oct 1 2016 |
| Externally published | Yes |
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ASJC Scopus subject areas
- Oncology
- Cancer Research
Cite this
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 journal › Article
}
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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U2 - 10.1093/jnci/djw121
DO - 10.1093/jnci/djw121
M3 - Article
C2 - 27235387
AN - SCOPUS:84994378069
VL - 108
JO - Journal of the National Cancer Institute
JF - Journal of the National Cancer Institute
SN - 0027-8874
IS - 10
M1 - djw121
ER -