title: Rate of growth in melanomas: characteristics and associations of rapidly growing melanomas.
abstract: OBJECTIVE
  To investigate the spectrum of growth rates in melanomas and to identify clinical associations of rapidly growing melanomas.
  
  
  METHODS
  Clinical interview, skin examination, and pathology review.
  
  
  METHODS
  Three tertiary melanoma referral centers and 2 private dermatology practices.
  
  
  METHODS
  A total of 404 consecutive patients with invasive primary cutaneous melanomas.
  
  
  METHODS
  A surrogate for rate of growth in primary invasive melanoma was calculated as the ratio of Breslow thickness to time to melanoma development based on a previously reported assessment tool.
  
  
  RESULTS
  One third of the melanomas grew 0.5 mm per month or more. The median monthly growth rate was 0.12 mm for superficial spreading melanomas, 0.13 mm for lentigo maligna melanomas, and 0.49 mm for nodular melanomas. Rapid tumor growth was associated with tumor thickness (<or=1 mm, geometric mean ratio [GMR] = 1.0; 1.01-4 mm, GMR = 3.9; and >4 mm, GMR = 12.1) and mitotic rate (<1/mm(2), GMR = 1.0; 1-4/mm(2), GMR = 2.9; 5-10/mm(2), GMR = 6.1; and >10/mm(2), GMR = 9.7). Rapid tumor growth occurred more often in males (GMR = 1.7), elderly individuals (>or=70 years old, GMR = 2.8), and patients with fewer melanocytic nevi (n<50, GMR = 2.0) and fewer freckles (GMR = 2.5). Rapidly growing melanomas were more often symmetrical (GMR = 2.5), elevated (GMR = 1.4), amelanotic (GMR = 1.7), regular in border (GMR = 2.5), and symptomatic (GMR = 1.7).
  
  
  CONCLUSIONS
  Rapid growth of primary cutaneous melanomas is associated with aggressive histologic features and atypical clinical features. It occurs more frequently in elderly men and individuals with fewer nevi and fewer freckles.
authors.affiliation: Victorian Melanoma Service, The Alfred Hospital, Melbourne, Australia. wendy.liu@petermac.org
authors.forename: Wendy
authors.initials: W
authors.lastname: Liu
authors.forename: John P
authors.initials: JP
authors.lastname: Dowling
authors.forename: William K
authors.initials: WK
authors.lastname: Murray
authors.forename: Grant A
authors.initials: GA
authors.lastname: McArthur
authors.forename: John F
authors.initials: JF
authors.lastname: Thompson
authors.forename: Rory
authors.initials: R
authors.lastname: Wolfe
authors.forename: John W
authors.initials: JW
authors.lastname: Kelly
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008545:Melanoma / Q000473:pathology*; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D012878:Skin Neoplasms / Q000473:pathology*; D011795:Surveys and Questionnaires