title: Age and gender are significant independent predictors of survival in primary cutaneous melanoma.
abstract: BACKGROUND
  The aim was to identify age- related and gender-related differences in the clinical presentation and outcome of patients with primary cutaneous melanoma (CM).
  
  
  METHODS
  A total of 4785 CM patients without clinical evidence of metastasis diagnosed during the period 1976-2001 in southern Germany included in the analysis. Kaplan-Meier analyses were performed to estimate and to compare disease-specific survival (DSS) and survival after first recurrence (SAR). The Cox proportional hazards model was used to evaluate the effect of multiple variables on DSS and SAR.
  
  
  RESULTS
  Increasing age and male gender were independently associated with thicker tumors (>2 mm) and histologic ulceration (P< .001). Patients older than 65 years had lower 10-year DSS than younger patients (81.8% vs 88.4%, P< .001) and this difference was more pronounced in women (P< .001) than in men (P= .06). Males had lower 10-year DSS than females (83.5% vs 88.5%, P< .001) but this difference did not reach statistical significance in patients older than 65 years (P= .162). In multivariate analysis adjusted for tumor thickness, ulceration, anatomic site, histologic subtype, DSS, site of first recurrence, time trend, sentinel lymph node status, age, and gender were independent predictors of DSS and SAR (P< .05).
  
  
  CONCLUSIONS
  Older age and male gender are associated with prognostically unfavorable primary CM. Expansion of current preventive strategies to target these subgroups is warranted. Moreover, age and gender are independent predictors of the outcome of CM patients. Females have a better prognosis than males but this difference disappears after the age of 65. Younger patients have a more favorable prognosis than older patients, a difference more pronounced in women.
authors.affiliation: Division of Dermatologic Oncology, Department of Dermatology, University of Tuebingen, Central Malignant Melanoma Registry of the German Dermatological Society, Tuebingen, Germany.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Lasithiotakis
authors.forename: Ulrike
authors.initials: U
authors.lastname: Leiter
authors.forename: Friedegund
authors.initials: F
authors.lastname: Meier
authors.forename: Thomas
authors.initials: T
authors.lastname: Eigentler
authors.forename: Gizela
authors.initials: G
authors.lastname: Metzler
authors.forename: Matthias
authors.initials: M
authors.lastname: Moehrle
authors.forename: Helmut
authors.initials: H
authors.lastname: Breuninger
authors.forename: Claus
authors.initials: C
authors.lastname: Garbe
mesh_terms: D000367:Age Factors; D000368:Aged; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008545:Melanoma / Q000401:mortality* / Q000473:pathology / Q000556:secondary; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology; D016016:Proportional Hazards Models; D021701:Sentinel Lymph Node Biopsy; D012737:Sex Factors; D012878:Skin Neoplasms / Q000401:mortality* / Q000473:pathology; D012883:Skin Ulcer / Q000473:pathology; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome