title: Immunosuppression is an independent prognostic factor associated with aggressive tumor behavior in cutaneous melanoma.
abstract: BACKGROUND
  A number of factors other than those identified by the American Joint Committee on Cancer (AJCC) may have prognostic significance in the evaluation of melanoma.
  
  
  OBJECTIVE
  We sought to evaluate commonly recorded clinical features potentially associated with aggressive melanoma.
  
  
  METHODS
  We conducted a retrospective case-control study. We included patients given a diagnosis of cutaneous melanoma with at least 5 years of follow-up or documented metastases. Patients were divided into nonaggressive and aggressive groups. Univariate and multivariate statistical analyses were performed to evaluate the association of multiple clinical and histologic parameters and metastases.
  
  
  RESULTS
  We included 141 patients. Significant prognostic factors in univariate analysis associated with nonaggressive disease included history of dysplastic nevus syndrome and ABCDE criteria. Significant factors in univariate analysis associated with aggressive disease included age and immunosuppression. Only age and immunosuppression remained significant in multivariate analysis when controlled across statistically significant histologic variables from AJCC.
  
  
  CONCLUSIONS
  The study is retrospective and has a small sample size.
  
  
  CONCLUSIONS
  Older patients and those with a history of immunosuppression may be at higher risk for aggressive disease and should be closely monitored after an initial diagnosis of melanoma.
authors.affiliation: Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
authors.forename: Tracy
authors.initials: T
authors.lastname: Donahue
authors.affiliation: Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
authors.forename: Christina Y
authors.initials: CY
authors.lastname: Lee
authors.affiliation: Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
authors.forename: Asmi
authors.initials: A
authors.lastname: Sanghvi
authors.affiliation: Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
authors.forename: Roxana
authors.initials: R
authors.lastname: Obregon
authors.affiliation: Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
authors.forename: Michael
authors.initials: M
authors.lastname: Sidiropoulos
authors.affiliation: Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
authors.forename: Chelsea
authors.initials: C
authors.lastname: Cooper
authors.affiliation: Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
authors.forename: Emily A
authors.initials: EA
authors.lastname: Merkel
authors.affiliation: Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
authors.forename: Oriol
authors.initials: O
authors.lastname: Yélamos
authors.affiliation: Department of Dermatology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors.forename: Laura
authors.initials: L
authors.lastname: Ferris
authors.affiliation: Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Robert H. Lurie Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois. Electronic address: pgerami1@nm.org.
authors.forename: Pedram
authors.initials: P
authors.lastname: Gerami
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000704:Analysis of Variance; D016022:Case-Control Studies; D004416:Dysplastic Nevus Syndrome / Q000276:immunology / Q000401:mortality / Q000473:pathology; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D007165:Immunosuppression Therapy; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D008297:Male; D008545:Melanoma / Q000276:immunology* / Q000401:mortality* / Q000473:pathology; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012878:Skin Neoplasms / Q000276:immunology* / Q000401:mortality* / Q000473:pathology; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D000096142:Cutaneous Malignant Melanoma
chemical_list: D007166:Immunosuppressive Agents
keywords: ABCDE criteria; age; dysplastic nevus syndrome; immunosuppression; melanoma; metastatic melanoma