title: Melanoma characteristics in Brazil: demographics, treatment, and survival analysis.
abstract: BACKGROUND
  The incidence of melanoma, one of the most aggressive of the skin cancers, has been increasing worldwide in the last few decades. Data from Latin America and Brazil remain scarce. We aimed to describe the demographic, clinical, and histopathological data; therapy characteristics; and survival rates of the Brazilian melanoma patient population.
  
  
  RESULTS
  We collected and analysed retrospective data from 15 years at a tertiary cancer centre. We describe patient characteristics and treatment. We calculated survival, and identified the main prognostic factors through univariate and multivariate analysis. We analysed a total of 1073 patients, with a mean age of 56.7 years. Men and women experienced similar prevalence, and 91.2% of patients had white skin. The most prevalent subtype was superficial spreading, and the most prevalent anatomic location was the trunk (32.2%), followed by the lower extremities (28%). Of all cases, 567 (52.9%) were assigned to clinical stages I and II, while 382 (32.6%) were stages III and IV. Surgery was the main treatment. Sentinel node biopsy was performed in 373 patients, with 23.8% positivity. Overall actuarial 5-year survival was 67.6%. Multivariate analysis showed that gender, serum lactate dehydrogenase (LDH) levels at diagnosis; anatomic location, TNM stage, and local recurrence were significant prognostic factors.
  
  
  CONCLUSIONS
  Overall survival was lower than worldwide rates. The main factors influencing survival were similar to those in other populations. Local recurrence was independently associated with lower survival rates. The high prevalence of advanced cases reinforces the importance of strategies to diagnose melanomas in the early stages. There is a need for future multi-institutional prospective studies to attain a better understanding of possible socioeconomic and other influences on survival among melanoma populations in Brazil and Latin America.
authors.affiliation: Department of Surgery, Melanoma/Sarcoma, Barretos Cancer Hospital, Rua Antenor Duarte Vilela, 1331, 14784-400, Barretos, São Paulo, Brazil. viniciusvazquez@gmail.com.|Research and Teaching Institute, Barretos Cancer Hospital, Barretos, São Paulo, Brazil. viniciusvazquez@gmail.com.|CPOM, Molecular Oncology Research Centre, Barretos Cancer Hospital, Barretos, São Paulo, Brazil. viniciusvazquez@gmail.com.|Barretos School of Health Sciences, Dr. Paulo Prata-FACISB, Barretos, São Paulo, Brazil. viniciusvazquez@gmail.com.
authors.forename: Vinicius de Lima
authors.initials: Vde L
authors.lastname: Vazquez
authors.affiliation: Research and Teaching Institute, Barretos Cancer Hospital, Barretos, São Paulo, Brazil. tbuosi@gmail.com.
authors.forename: Thiago Buosi
authors.initials: TB
authors.lastname: Silva
authors.affiliation: Department of Surgery, Melanoma/Sarcoma, Barretos Cancer Hospital, Rua Antenor Duarte Vilela, 1331, 14784-400, Barretos, São Paulo, Brazil. mvieiraonco@gmail.com.
authors.forename: Marcelo de Andrade
authors.initials: Mde A
authors.lastname: Vieira
authors.affiliation: Department of Surgery, Melanoma/Sarcoma, Barretos Cancer Hospital, Rua Antenor Duarte Vilela, 1331, 14784-400, Barretos, São Paulo, Brazil. netto123@uol.com.br.
authors.forename: Antônio Talvane Torres
authors.initials: AT
authors.lastname: de Oliveira
authors.affiliation: Oncology Unit, Marcio Cunha Hospital, Ipatinga, Minas Gerais, Brazil. vitalisboa@gmail.com.
authors.forename: Marcílio Vital
authors.initials: MV
authors.lastname: Lisboa
authors.affiliation: InORP, Oncologic Institute, Rua Ayrton Roxo, 571 CEP, 14025-270, Ribeirão Preto, São Paulo, Brazil. diocesio@yahoo.com.
authors.forename: Diocésio Alves Pinto
authors.initials: DA
authors.lastname: de Andrade
authors.affiliation: Research and Teaching Institute, Barretos Cancer Hospital, Barretos, São Paulo, Brazil. mdfregnani@terra.com.br.
authors.forename: José Humberto Tavares Guerreiro
authors.initials: JH
authors.lastname: Fregnani
authors.affiliation: Proestat Statistical Institute, Ribeirão Preto, São Paulo, Brazil. estela.federal@gmail.com.
authors.forename: Estela Cristina
authors.initials: EC
authors.lastname: Carneseca
mesh_terms: D001938:Brazil / Q000453:epidemiology; D003710:Demography; D005260:Female; D006801:Humans; D008297:Male; D008545:Melanoma / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D021701:Sentinel Lymph Node Biopsy; D016019:Survival Analysis