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Association Between Thin Melanomas and Atypical Nevi in Middle-aged and Older Men Possibly Attributable to Heightened Patient Awareness

Association Between Thin Melanomas and Atypical Nevi in Middle-aged and Older Men Possibly... We read with interest the article “Melanoma in Middle-aged and Older Men” by Swetter et al.1 As the authors noted, men with atypical nevi presented with thinner melanomas than those who lacked atypical nevi. According to the study data, median tumor thickness in men with atypical nevi was 0.6 mm, whereas the median thickness was 1.15 mm in men without atypical nevi (P = .02). The authors suggest that men with atypical nevi may have greater knowledge and awareness of melanoma risk, resulting in earlier detection of their melanomas. Another explanation, suggested by Liu et al,2 is that patients with atypical or increased numbers of moles have more indolent melanomas and thus present with thinner tumors. Methods To reconcile these alternate explanations, we analyzed the New York University (NYU) database of patients with melanoma prospectively enrolled from 1972 through 1982, many years prior to our colleagues' publication of the melanoma ABCD rule (asymmetry, borders, colors, and diameter >6 mm)3 and during an era of much less public awareness of the importance of early melanoma detection. Each patient in the NYU cohort was assessed for numerous clinical factors, including number of nevi.4 However, these patients were enrolled before the significance of atypical nevi was recognized as a risk factor for melanoma, so counts of atypical nevi were not recorded for any patient in the database. Multiple studies, including Roush and Barnhill5 and Nordlund et al,6 have found that individuals with atypical nevi have a higher number of total nevi. These publications suggest that an analysis of number of nevi and median tumor thickness is comparable to the analysis of atypical nevi and tumor thickness performed by Swetter et al.1 Results The accompanying Table and box plot (Figure) summarize data from all men older than 40 years in our cohort (n = 419) and show that tumor thickness did not vary significantly with the number of moles (P >.99 in the Kruskal-Wallis nonparametric analysis of variance test). These data suggest that melanomas arising in patients with increased numbers of nevi are not inherently more indolent than melanomas arising in patients with an average (or less than average) number of nevi. View LargeDownload Figure. Box plot of melanoma tumor thickness grouped by mole count. Box heights represent the interquartile distances; horizontal lines, medians; plus signs, means; and vertical lines extending above and below the boxes, maximum and minimum values observed. Table. Tumor Thickness by Number of Moles View LargeDownload Comment Although these data contrast with those of Swetter et al,1 taken together these findings suggest that increased public awareness and educational efforts may have led to earlier detection of melanoma. Swetter et al demonstrated that men who were aware of melanoma, understood the importance of skin examinations, and showed an overall interest in their health were more likely to present with thinner tumors. At our own institution, we have noted a substantial decrease in tumor thickness among patients with melanoma who were enrolled in studies this decade compared to those enrolled between 1972 and 1982.4 These data support the idea that public awareness, particularly in patients with atypical and increased numbers of moles, leads to earlier detection of melanoma and better survival. As most patients with melanoma do not have an increased number of moles, an important challenge is to develop new risk assessment tools, including genetic markers. This will enable us to identify and educate individuals who lack the established risk factors but are nevertheless at increased risk for melanoma. Back to top Article Information Correspondence: Dr Polsky, Ronald O. Perelman Department of Dermatology, NYU Langone Medical Center, 522 First Ave, New York, NY 10016 (David.Polsky@nyumc.org). Financial Disclosure: None reported. Funding/Support: This study was supported in part by the Irwin I. Lubowe Fellowship in Dermatology (Dr Stein), The Ronald O. Perelman Department of Dermatology (Dr Hamilton), and the NYU Cancer Institute (Ms Tay). References 1. Swetter SMJohnson TMMiller DRLayton CJBrooks KRGeller AC Melanoma in middle-aged and older men: a multi-institutional survey study of factors related to tumor thickness. Arch Dermatol20091454397404PubMedGoogle Scholar 2. Liu WDowling JPMurray WK et al Rate of growth in melanomas: characteristics and associations of rapidly growing melanomas. Arch Dermatol20061421215511558PubMedGoogle Scholar 3. Friedman RJRigel DSKopf AW Early detection of malignant melanoma: the role of physician examination and self-examination of the skin. CA Cancer J Clin1985353130151PubMedGoogle Scholar 4. Warycha MAChristos JPMazumdar M et al Changes in the presentation of nodular and superficial spreading melanomas over 35 years. Cancer20081131233413348PubMedGoogle Scholar 5. Roush GCBarnhill RL Correlation of clinical pigmentary characteristics with histopathologically-confirmed dysplastic nevi in nonfamilial melanoma a patients: studies of melanocytic nevi IX. Br J Cancer1991645943947PubMedGoogle Scholar 6. Nordlund JJKirkwood JForget BM et al Demographic study of clinically atypical (dysplastic) nevi in patients with melanoma and comparison subjects. Cancer Res198545418551861PubMedGoogle Scholar http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Dermatology American Medical Association

Association Between Thin Melanomas and Atypical Nevi in Middle-aged and Older Men Possibly Attributable to Heightened Patient Awareness

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Publisher
American Medical Association
Copyright
Copyright © 2009 American Medical Association. All Rights Reserved.
ISSN
0003-987X
eISSN
1538-3652
DOI
10.1001/archdermatol.2009.309
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Abstract

We read with interest the article “Melanoma in Middle-aged and Older Men” by Swetter et al.1 As the authors noted, men with atypical nevi presented with thinner melanomas than those who lacked atypical nevi. According to the study data, median tumor thickness in men with atypical nevi was 0.6 mm, whereas the median thickness was 1.15 mm in men without atypical nevi (P = .02). The authors suggest that men with atypical nevi may have greater knowledge and awareness of melanoma risk, resulting in earlier detection of their melanomas. Another explanation, suggested by Liu et al,2 is that patients with atypical or increased numbers of moles have more indolent melanomas and thus present with thinner tumors. Methods To reconcile these alternate explanations, we analyzed the New York University (NYU) database of patients with melanoma prospectively enrolled from 1972 through 1982, many years prior to our colleagues' publication of the melanoma ABCD rule (asymmetry, borders, colors, and diameter >6 mm)3 and during an era of much less public awareness of the importance of early melanoma detection. Each patient in the NYU cohort was assessed for numerous clinical factors, including number of nevi.4 However, these patients were enrolled before the significance of atypical nevi was recognized as a risk factor for melanoma, so counts of atypical nevi were not recorded for any patient in the database. Multiple studies, including Roush and Barnhill5 and Nordlund et al,6 have found that individuals with atypical nevi have a higher number of total nevi. These publications suggest that an analysis of number of nevi and median tumor thickness is comparable to the analysis of atypical nevi and tumor thickness performed by Swetter et al.1 Results The accompanying Table and box plot (Figure) summarize data from all men older than 40 years in our cohort (n = 419) and show that tumor thickness did not vary significantly with the number of moles (P >.99 in the Kruskal-Wallis nonparametric analysis of variance test). These data suggest that melanomas arising in patients with increased numbers of nevi are not inherently more indolent than melanomas arising in patients with an average (or less than average) number of nevi. View LargeDownload Figure. Box plot of melanoma tumor thickness grouped by mole count. Box heights represent the interquartile distances; horizontal lines, medians; plus signs, means; and vertical lines extending above and below the boxes, maximum and minimum values observed. Table. Tumor Thickness by Number of Moles View LargeDownload Comment Although these data contrast with those of Swetter et al,1 taken together these findings suggest that increased public awareness and educational efforts may have led to earlier detection of melanoma. Swetter et al demonstrated that men who were aware of melanoma, understood the importance of skin examinations, and showed an overall interest in their health were more likely to present with thinner tumors. At our own institution, we have noted a substantial decrease in tumor thickness among patients with melanoma who were enrolled in studies this decade compared to those enrolled between 1972 and 1982.4 These data support the idea that public awareness, particularly in patients with atypical and increased numbers of moles, leads to earlier detection of melanoma and better survival. As most patients with melanoma do not have an increased number of moles, an important challenge is to develop new risk assessment tools, including genetic markers. This will enable us to identify and educate individuals who lack the established risk factors but are nevertheless at increased risk for melanoma. Back to top Article Information Correspondence: Dr Polsky, Ronald O. Perelman Department of Dermatology, NYU Langone Medical Center, 522 First Ave, New York, NY 10016 (David.Polsky@nyumc.org). Financial Disclosure: None reported. Funding/Support: This study was supported in part by the Irwin I. Lubowe Fellowship in Dermatology (Dr Stein), The Ronald O. Perelman Department of Dermatology (Dr Hamilton), and the NYU Cancer Institute (Ms Tay). References 1. Swetter SMJohnson TMMiller DRLayton CJBrooks KRGeller AC Melanoma in middle-aged and older men: a multi-institutional survey study of factors related to tumor thickness. Arch Dermatol20091454397404PubMedGoogle Scholar 2. Liu WDowling JPMurray WK et al Rate of growth in melanomas: characteristics and associations of rapidly growing melanomas. Arch Dermatol20061421215511558PubMedGoogle Scholar 3. Friedman RJRigel DSKopf AW Early detection of malignant melanoma: the role of physician examination and self-examination of the skin. CA Cancer J Clin1985353130151PubMedGoogle Scholar 4. Warycha MAChristos JPMazumdar M et al Changes in the presentation of nodular and superficial spreading melanomas over 35 years. Cancer20081131233413348PubMedGoogle Scholar 5. Roush GCBarnhill RL Correlation of clinical pigmentary characteristics with histopathologically-confirmed dysplastic nevi in nonfamilial melanoma a patients: studies of melanocytic nevi IX. Br J Cancer1991645943947PubMedGoogle Scholar 6. Nordlund JJKirkwood JForget BM et al Demographic study of clinically atypical (dysplastic) nevi in patients with melanoma and comparison subjects. Cancer Res198545418551861PubMedGoogle Scholar

Journal

Archives of Dermatology – American Medical Association

Published: Dec 1, 2009

Keywords: melanoma,middle-aged adult,dysplastic nevus,older adult

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