Factors associated with improved survival among young adult melanoma patients despite a greater incidence of sentinel lymph node metastasis.
BACKGROUND
We sought to evaluate the factors that affect sentinel lymph node (SLN) metastasis and survival among young melanoma patients (< or =30 y).


METHODS
The Sunbelt Melanoma Trial is a multi-institutional prospective randomized trial of patients aged 18 to 70 y. Statistical analyses were performed to determine if patients < or =30 y of age had a significantly different outcome in terms of SLN metastasis, disease-free survival (DFS), and overall survival (OS) compared to older patients.


RESULTS
The median age of the 3031 patients in this study was 50 y (range 18 to 77 y); the 315 patients (10.4%) < or =30 y old were compared with those >30 y old. Of the 1944 patients with follow-up, the median follow-up was 48 mo. On univariate analysis, younger patients were more often female (54.7% versus 40.9%, P < 0.0005), with tumors <4 mm thick (94.9% versus 89.4%, P = 0.001) without ulceration (80.3% versus 70.9%, P < 0.0005) or evidence of regression (93.8% versus 87.8%, P = 0.003), and were less likely to have lentigo maligna (0.0% versus 2.6%) or acral lentiginous (0.4% versus 3.1%, P < 0.0005) subtype. Patient age < or =30 was associated with SLN metastasis on univariate (24.6% versus 19.7%, P = 0.05) and multivariate (OR = 1.77, 95% CI = 1.26-2.49, P = 0.001) analyses. With a median follow-up of 48 mo, younger patients had a significantly improved 5-y DFS (86.2% versus 79.1%, P = 0.036) and OS (89.9% versus 80.1%, P = 0.010). On multivariable Cox regression analysis, however, age group was not a significant independent prognostic factor affecting DFS or OS.


CONCLUSIONS
Despite a higher rate of SLN metastasis, patients < or =30 y old do not have a worse survival attributable to a more favorable clinicopathologic profile.
Chagpar
Ryaz B
RB
University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
Ross
Merrick I
MI
Reintgen
Douglas S
DS
Edwards
Michael J
MJ
Scoggins
Charles R
CR
Martin
Robert C G
RC
Noyes
R Dirk
RD
Goydos
James S
JS
Beitsch
Peter D
PD
Urist
Marshall M
MM
Ariyan
Stephan
S
Davidson
B Scott
BS
Sussman
Jeffrey J
JJ
McMasters
Kelly M
KM
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008207:Lymphatic Metastasis / Q000175:diagnosis*; D008297:Male; D008545:Melanoma / Q000150:complications / Q000175:diagnosis* / Q000401:mortality; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D011446:Prospective Studies; D021701:Sentinel Lymph Node Biopsy; D012727:Sex Characteristics; D012878:Skin Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000401:mortality