title: Red meat and fruit intake is prognostic among patients with localized cutaneous melanomas more than 1mm thick.
abstract: BACKGROUND
  As the 10-year mortality for localized cutaneous melanoma more than 1.00 mm thick approaches 40% following complete resection, non-therapeutic interventions that can supplement recommended active surveillance are needed. Although guidelines recommending nutrition, physical activity and tobacco cessation for cancer survivors have been published, data describing their associations with melanoma survivorship are lacking.
  
  
  METHODS
  Analysis of modifiable lifestyle behaviors collected on the 249 cases with melanomas more than 1.00 mm thick enrolled in the Connecticut Case-Control Study of Skin Self-Examination study was conducted. Independent associations with melanoma-specific survival were evaluated through Cox proportional hazards modeling adjusting for age, gender, Breslow thickness, ulceration and the presence of microsatellites. Independently significant variables were then combined into a single model and backwards elimination was employed until all remaining variables were significant at p<0.05.
  
  
  RESULTS
  Following adjustment for age, Breslow thickness and anatomic site of the index melanoma, daily fruit consumption was associated with improved melanoma-specific survival (HR=0.54; 95% CI: 0.34-0.86) whereas at least weekly red meat consumption was associated with worse outcomes (HR=1.84; 95% CI: 1.02-3.30). Natural red (HR=0.44; 95% CI: 0.22-0.88) or blond (HR=0.52; 95% CI: 0.29-0.94) hair were also favorably prognostic. Higher fish consumption was of borderline significance for improved survival only when considered independently (HR=0.65; 95% CI: 0.40-1.05); no association was seen following adjustment for red meat and fruit consumption (p>0.10).
  
  
  CONCLUSIONS
  Dietary choices at the time of diagnosis are associated with melanoma-specific survival in patients with melanomas more than 1.00 mm thick. Further validation of our findings in larger cohorts with repeated post-diagnostic measures is warranted to further evaluate whether dietary modification during the survivorship period can improve melanoma-specific survival.
authors.affiliation: Yale Cancer Center, Yale School of Medicine, 333 Cedar Street, New Haven, CT 06520-8028, USA; Department of Internal Medicine, Yale School of Medicine, 333 Cedar Street, New Haven, CT 06520-8028, USA; Department of Pathology, Yale School of Medicine, 333 Cedar Street, New Haven, CT 06520-8028, USA; Department of Chronic Disease Epidemiology, Yale School of Public Health, 60 College Street, New Haven, CT 06520-8034, USA. Electronic address: bonnie.gouldrothberg@yale.edu.
authors.forename: Bonnie E
authors.initials: BE
authors.lastname: Gould Rothberg
authors.affiliation: Yale Cancer Center, Yale School of Medicine, 333 Cedar Street, New Haven, CT 06520-8028, USA. Electronic address: Kaleigh.bulloch@yale.edu.
authors.forename: Kaleigh J
authors.initials: KJ
authors.lastname: Bulloch
authors.affiliation: University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030, USA. Electronic address: judie7168@gmail.com.
authors.forename: Judith A
authors.initials: JA
authors.lastname: Fine
authors.affiliation: Department of Pathology and Laboratory Medicine, University of California, Los Angeles School of Medicine, 10833 Le Conte Avenue, Los Angeles, CA 90095, USA. Electronic address: rbarnhill@mednet.ucla.edu.
authors.forename: Raymond L
authors.initials: RL
authors.lastname: Barnhill
authors.affiliation: Department of Internal Medicine, University of New Mexico, MSC 10-5550, 1 University of New Mexico, Albuquerque, NM 87131, USA; Department of Dermatology, University of New Mexico, MSC 10-5550, 1 University of New Mexico, Albuquerque, NM 87131, USA. Electronic address: mberwick@salud.unm.edu.
authors.forename: Marianne
authors.initials: M
authors.lastname: Berwick
mesh_terms: D000368:Aged; D000818:Animals; D016022:Case-Control Studies; D004032:Diet; D005260:Female; D005399:Fishes; D005500:Follow-Up Studies; D005638:Fruit; D006200:Hair Color / Q000502:physiology; D006801:Humans; D008019:Life Style; D008297:Male; D008460:Meat; D008545:Melanoma / Q000453:epidemiology* / Q000473:pathology; D008875:Middle Aged; D011379:Prognosis; D012878:Skin Neoplasms / Q000453:epidemiology* / Q000473:pathology; D015996:Survival Rate
keywords: Alcohol use; Body mass index; Cutaneous melanoma; Fish; Fruit; Hair color; Mortality; Prognosis; Red meat; Smoking