title: Gender-related differences in outcome for melanoma patients.
abstract: OBJECTIVE
  To better understand the factors associated with the well-established gender difference in survival for patients with melanoma.
  
  
  BACKGROUND
  Gender is an important factor in patients with cutaneous melanoma. Male patients have a worse outcome when compared with females. The reasons for this difference are poorly understood.
  
  
  METHODS
  This prospective multi-institutional study included patients aged 18 to 70 years with melanomas > or =1.0 mm Breslow thickness. Wide excision and sentinel lymph node (SLN) biopsy was performed in all patients. Clinicopathologic factors, including gender, were assessed and correlated with disease-free survival (DFS), distant disease-free survival (DDFS), and overall survival (OS).
  
  
  RESULTS
  A total of 3324 patients were included in the covariate analyses; 1829 patients had follow-up data available and were included in the survival analyses. Median follow-up was 30 months. On univariate analysis, men (n = 1906) were more likely than women to be older than 60 years (P < 0.0001), have thicker melanomas (P < 0.0001), have primary tumor regression (P = 0.0054), ulceration (P < 0.0001), and axial primary tumor location (P < 0.0001). On multivariate analysis, age (P = 0.0002), thickness (P < 0.0001), ulceration (P = 0.015), and location (P < 0.0001) remained significant in the model. There was no difference in the rate of SLN metastasis between men and women (P = 0.37) on multivariate analysis. When factors affecting survival were considered, the prognosis was worse for men as validated by lower DFS (P = 0.0005), DDFS (P < 0.0001), and OS (P < 0.0001).
  
  
  CONCLUSIONS
  Male gender is associated with a greater incidence of unfavorable primary tumor characteristics without an increased risk for nodal metastasis. Nonetheless, gender is an independent factor affecting survival.
authors.affiliation: Division of Surgical Oncology, Department of Surgery, University of Louisville, KY 40292, USA.
authors.forename: Charles R
authors.initials: CR
authors.lastname: Scoggins
authors.forename: Merrick I
authors.initials: MI
authors.lastname: Ross
authors.forename: Douglas S
authors.initials: DS
authors.lastname: Reintgen
authors.forename: R Dirk
authors.initials: RD
authors.lastname: Noyes
authors.forename: James S
authors.initials: JS
authors.lastname: Goydos
authors.forename: Peter D
authors.initials: PD
authors.lastname: Beitsch
authors.forename: Marshall M
authors.initials: MM
authors.lastname: Urist
authors.forename: Stephan
authors.initials: S
authors.lastname: Ariyan
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Sussman
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Edwards
authors.forename: Anees B
authors.initials: AB
authors.lastname: Chagpar
authors.forename: Robert C G
authors.initials: RC
authors.lastname: Martin
authors.forename: Arnold J
authors.initials: AJ
authors.lastname: Stromberg
authors.forename: Lee
authors.initials: L
authors.lastname: Hagendoorn
authors.forename: Kelly M
authors.initials: KM
authors.lastname: McMasters
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008545:Melanoma / Q000401:mortality* / Q000473:pathology*; D008875:Middle Aged; D011446:Prospective Studies; D021701:Sentinel Lymph Node Biopsy; D012737:Sex Factors; D012878:Skin Neoplasms / Q000401:mortality* / Q000473:pathology*; D015996:Survival Rate