title: Prognostic factors and disease-specific survival among immigrants diagnosed with cutaneous malignant melanoma in Sweden.
abstract: Little is known about cutaneous malignant melanoma (CMM) among immigrants in Europe. We aimed to investigate clinical characteristics and disease-specific survival among first- and second-generation immigrants in Sweden. This nationwide population-based study included 27,235 patients from the Swedish Melanoma Register diagnosed with primary invasive CMM, 1990-2007. Data were linked to nationwide, population-based registers followed up through 2013. Logistic regression and Cox regression models were used to determine the association between immigrant status, stage and CMM prognosis, respectively. After adjustments for confounders, first generation immigrants from Southern Europe were associated with significantly more advanced stages of disease compared to Swedish-born patients [Stage II vs. I: Odds ratio (OR) = 2.37, 95% CI = 1.61-3.50. Stage III-IV vs I: OR = 2.40, 95% CI = 1.08-5.37]. The ORs of stage II-IV versus stage I disease were increased among men (OR = 1.9; 95% CI = 1.1-3.3; p = 0.020), and women (OR = 4.8; 95% CI = 2.6-9.1; p < 0.001) in a subgroup of immigrants from former Yugoslavia compared to Swedish-born patients. The CMM-specific survival was significantly decreased among women from former Yugoslavia versus Swedish-born women [hazard ratio (HR)=2.2; 95% CI = 1.1-4.2; p = 0.043]. After additional adjustments including stage, the survival difference was no longer significant. No survival difference between the second generation immigrant group and Swedish-born patients were observed. In conclusion, a worse CMM-specific survival in women from former Yugoslavia was associated with more advanced stages of CMM at diagnosis. Secondary prevention efforts focusing on specific groups may be needed to further improve the CMM prognosis.
authors.affiliation: Department of Oncology and Pathology, Karolinska Institutet, Stockholm, SE, 171 76, Sweden.|Department of Dermatology and Venereology, Södersjukhuset, Stockholm, SE, 118 83, Sweden.
authors.forename: Caroline
authors.initials: C
authors.lastname: Simberg-Danell
authors.affiliation: Unit of Research and Development in Local Health Care, County of Östergötland, Linköping, Sweden.
authors.forename: Johan
authors.initials: J
authors.lastname: Lyth
authors.affiliation: Department of Oncology and Pathology, Karolinska Institutet, Stockholm, SE, 171 76, Sweden.|Department of Oncology and Pathology, Karolinska University Hospital, Stockholm, SE, 171 76, Sweden.
authors.forename: Eva
authors.initials: E
authors.lastname: Månsson-Brahme
authors.affiliation: Department of Medicine, Unit of Dermatology, Karolinska University Hospital, Stockholm, SE, 171 76, Sweden.
authors.forename: Margareta
authors.initials: M
authors.lastname: Frohm-Nilsson
authors.affiliation: Division of Health Care Analysis, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
authors.forename: John
authors.initials: J
authors.lastname: Carstensen
authors.affiliation: Department of Oncology and Pathology, Karolinska Institutet, Stockholm, SE, 171 76, Sweden.|Department of Oncology and Pathology, Karolinska University Hospital, Stockholm, SE, 171 76, Sweden.
authors.forename: Johan
authors.initials: J
authors.lastname: Hansson
authors.affiliation: Department of Oncology and Pathology, Karolinska Institutet, Stockholm, SE, 171 76, Sweden.|Department of Oncology and Pathology, Karolinska University Hospital, Stockholm, SE, 171 76, Sweden.
authors.forename: Hanna
authors.initials: H
authors.lastname: Eriksson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D054242:Emigrants and Immigrants; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008545:Melanoma / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D016017:Odds Ratio; D011159:Population Surveillance; D011379:Prognosis; D012042:Registries; D012878:Skin Neoplasms; D012959:Socioeconomic Factors; D016019:Survival Analysis; D013548:Sweden / Q000453:epidemiology; D055815:Young Adult; D000096142:Cutaneous Malignant Melanoma
keywords: cutaneous malignant melanoma; immigrants; nationwide; population-based; prognosis