title: Role of obesity on the thickness of primary cutaneous melanoma.
abstract: BACKGROUND
  Thick primary cutaneous melanoma (PCM) is associated with older age, male sex, being single, a low educational level, self-detection and general practice detection, nodular melanoma (NM) and acral lentiginous melanoma (ALM) types; and are found in the head-neck and lower limb locations. Obesity plays a direct role on melanoma tumour growth, as it has been shown in animal models, but its role in the thickness of PCM remains unknown.
  
  
  OBJECTIVE
  We investigated the impact of obesity on the thickness of invasive PCM.
  
  
  METHODS
  A cross-sectional study was performed in a prospective cohort for which we collected several clinical and histological data already known to be associated with thick PCM and the Body Mass Index from new cases of invasive PCM which were referred to the dermatology department in Valence.
  
  
  RESULTS
  Four hundred and twenty-seven patients were studied. In an univariate analysis, thick PCM was associated with low educational level, obesity, identification by the patient or the general practitioner (GP), location on the cephalic extremity, in a non-visible area of the body, the NM and ALM type, and an ulceration. In a multivariate analysis, NM, ulceration, topography of the melanoma and identification of the melanoma by the patient or GP were significantly associated with thick melanoma. When including only clinical features in the model, low educational level, mode of melanoma identification and obesity were significantly associated with a risk of thick melanoma.
  
  
  CONCLUSIONS
  Obesity is a clinical independent risk factor of thick PCM. For health policies, governments should pay greater attention to detect melanoma in obese patients. Our results encourage the basic research on tumoural growth mechanisms due to obesity in melanoma.
authors.affiliation: Service de Dermatologie, Centre Hospitalier de Valence, Valence, France.
authors.forename: F
authors.initials: F
authors.lastname: Skowron
authors.affiliation: Service d'immunoallergologie, Centre Hospitalier Lyon Sud, Pierre Bénite, France.
authors.forename: F
authors.initials: F
authors.lastname: Bérard
authors.affiliation: Service de dermatopathologie, Centre Hospitalier Lyon Sud, Pierre Bénite, France.
authors.forename: B
authors.initials: B
authors.lastname: Balme
authors.affiliation: Service de Biostatistiques, Hospices Civils de Lyon, Lyon, France.|CNRS UMR 5558, Equipe Biostatistique Santé, Pierre-Bénite, France.|Université Lyon I, Villeurbanne, France.
authors.forename: D
authors.initials: D
authors.lastname: Maucort-Boulch
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008545:Melanoma / Q000453:epidemiology / Q000473:pathology*; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000150:complications* / Q000209:etiology; D011379:Prognosis; D012307:Risk Factors; D012878:Skin Neoplasms / Q000453:epidemiology / Q000473:pathology*; D055815:Young Adult
references.citation: Thompson JF, Soong SJ, Balch CM et al. Prognostic significance of mitotic rate in localized primary cutaneous melanoma: an analysis of patients in the multi-institutional American Joint Committee on Cancer melanoma staging database. J Clin Oncol 2011; 29: 2199-2205.
references.citation: Grange F, Barbe C, Aubin F et al. Clinical and Sociodemographic Characteristics Associated With Thick Melanomas: a Population-Based, Case-Case Study in France. Arch Dermatol 2012; 148: 1-7.
references.citation: Youl PH, Baade PD, Parekh S et al. Association between melanoma thickness, clinical skin examination and socioeconomic status: results of a large population-based study. Int J Cancer 2011; 128: 2158-2165.
references.citation: Mandala M, Imberti GL, Piazzalunga D et al. Association of socioeconomic status with Breslow thickness and disease-free and overall survival in stage I-II primary cutaneous melanoma. Mayo Clin Proc 2011; 86: 113-119.
references.citation: Pennie ML, Soon SL, Risser JB et al. Melanoma outcomes for Medicare patients: association of stage and survival with detection by a dermatologist vs a nondermatologist. Arch Dermatol 2007; 143: 488-494.
references.citation: Baumert J, Plewig G, Volkenandt M et al. Factors associated with a high tumour thickness in patients with melanoma. Br J Dermatol 2007; 156: 938-944.
references.citation: Vucenik I, Stains JP. Obesity and cancer risk: evidence, mechanisms, and recommendations. Ann N Y Acad Sci 2012; 1271: 37-43.
references.citation: Sergentanis TN, Antoniadis AG, Gogas HJ et al. Obesity and risk of malignant melanoma: a meta-analysis of cohort and case-control studies. Eur J Cancer 2013; 49: 642-657.
references.citation: Hursting SD, Dunlap SM. Obesity, metabolic dysregulation, and cancer: a growing concern and an inflammatory (and microenvironmental) issue. Ann N Y Acad Sci 2012; 1271: 82-87.
references.citation: Shipman AR, Millington GW. Obesity and the skin. Br J Dermatol 2011; 165: 743-750.
references.citation: Balch CM, Gershenwald JE, Soong SJ et al. Final version of 2009 AJCC melanoma staging and classification. J Clin Oncol 2009; 27: 6199-6206.
references.citation: R Development Core Team. R: A Language Environment for Statistical Computing. Vienna, Austria. ISBN 3-900051-07-0. URL: http://www.R-project.org 2011.
references.citation: Charles MA, Eschwege E, Basdevant A. Monitoring the obesity epidemic in France: the Obepi surveys 1997-2006. Obesity (Silver Spring) 2008; 16: 2182-2186.
references.citation: Durbec F, Vitry F, Granel-Brocard F et al. The role of circumstances of diagnosis and access to dermatological care in early diagnosis of cutaneous melanoma: a population-based study in France. Arch Dermatol 2010; 146: 240-246.
references.citation: Geller AC, Elwood M, Swetter SM et al. Factors related to the presentation of thin and thick nodular melanoma from a population-based cancer registry in Queensland Australia. Cancer 2009; 115: 1318-1327.
references.citation: Nagore E, Oliver V, Botella-Estrada R et al. Clinicopathological analysis of 1571 cutaneous malignant melanomas in Valencia, Spain: factors related to tumour thickness. Acta Derm Venereol 2006; 86: 50-56.
references.citation: Baade PD, English DR, Youl PH et al. The relationship between melanoma thickness and time to diagnosis in a large population-based study. Arch Dermatol 2006; 142: 1422-1427.
references.citation: Carli P, De Giorgi V, Palli D et al. Dermatologist detection and skin self-examination are associated with thinner melanomas: results from a survey of the Italian Multidisciplinary Group on Melanoma. Arch Dermatol 2003; 139: 607-612.
references.citation: Schwartz JL, Wang TS, Hamilton TA et al. Thin primary cutaneous melanomas: associated detection patterns, lesion characteristics, and patient characteristics. Cancer 2002; 95: 1562-1568.
references.citation: Montella M, Crispo A, Grimaldi M et al. An assessment of factors related to tumor thickness and delay in diagnosis of melanoma in southern Italy. Prev Med 2002; 35: 271-277.
references.citation: Chamberlain AJ, Fritschi L, Giles GG et al. Nodular type and older age as the most significant associations of thick melanoma in Victoria, Australia. Arch Dermatol 2002; 138: 609-614.
references.citation: Richard MA, Grob JJ, Avril MF et al. Delays in diagnosis and melanoma prognosis (I): the role of patients. Int J Cancer 2000; 89: 271-279.
references.citation: Richard MA, Grob JJ, Avril MF et al. Delays in diagnosis and melanoma prognosis (II): the role of doctors. Int J Cancer 2000; 89: 280-285.
references.citation: Oliveria SA, Christos PJ, Halpern AC et al. Patient knowledge, awareness, and delay in seeking medical attention for malignant melanoma. J Clin Epidemiol 1999; 52: 1111-1116.
references.citation: Stratigos AJ, Katsambas AD. The value of screening in melanoma. Clin Dermatol 2009; 27: 10-25.
references.citation: Risica PM, Weinstock MA, Rakowski W et al. Body satisfaction effect on thorough skin self-examination. Am J Prev Med 2008; 35: 68-72.
references.citation: Li X, Liang L, Zhang M et al. Obesity-related genetic variants, human pigmentation, and risk of melanoma. Hum Genet 2013; 132: 793-801.
references.citation: Nieman KM, Romero IL, Van Houten B et al. Adipose tissue and adipocytes support tumorigenesis and metastasis. Biochim Biophys Acta 2013; 1831: 1533-1541.
references.citation: Cao L, Liu X, Lin EJ et al. Environmental and genetic activation of a brain-adipocyte BDNF/leptin axis causes cancer remission and inhibition. Cell 2010; 142: 52-64.
references.citation: Brandon EL, Gu JW, Cantwell L et al. Obesity promotes melanoma tumor growth: role of leptin. Cancer Biol Ther 2009; 8: 1871-1879.
references.citation: Pandey V, Vijayakumar MV, Ajay AK et al. Diet-induced obesity increases melanoma progression: involvement of Cav-1 and FASN. Int J Cancer 2012; 130: 497-508.
references.citation: de Giorgi V, Gori A, Grazzini M et al. Obesity and melanoma. Br J Dermatol 2012; 166: 1357-1358.