Does the morphology of cutaneous melanoma help explain the international differences in survival? Results from 1,578,482 adults diagnosed during 2000‐2014 in 59 countries (CONCORD ‐3)

Di Carlo, V. et al. (2022) Does the morphology of cutaneous melanoma help explain the international differences in survival? Results from 1,578,482 adults diagnosed during 2000‐2014 in 59 countries (CONCORD ‐3). British Journal of Dermatology, 187(3), pp. 364-380. (doi: 10.1111/bjd.21274) (PMID:35347700) (PMCID:PMC9542891)

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Abstract

Background: CONCORD-3 highlighted wide disparities in population-based 5-year net survival during 2000-2014. Clinical evidence suggests marked international differences in the proportion of lethal acral and nodular subtypes. Objectives: We aim to assess whether the differences in morphology may explain global variation in survival. Methods: We grouped melanoma into seven morphology categories: malignant melanoma, not otherwise specified (ICD-O-3 morphology code 8720), superficial spreading melanoma (8743), lentigo maligna melanoma (8742), nodular melanoma (8721), acral lentiginous melanoma (8744), desmoplastic melanoma (8745) and other morphologies (8722-8723, 8726-8727, 8730, 8740-8741, 8746, 8761, 8770-8774, 8780). We estimated net survival with the non-parametric Pohar-Perme estimator, correcting for background mortality by single year of age, sex and calendar year in each country or region. All-ages survival estimates were standardised with the International Cancer Survival Standard weights. We fitted a flexible parametric model to estimate the effect of morphology on the hazard of death. Results: Worldwide, the proportion of nodular melanoma ranged between 7%-13%. Acral lentiginous melanoma accounted for less than 2% of all registrations but was more common in Asia (6%) and Central and South America (7%). 36% of tumours were classified as superficial spreading melanoma. During 2010-2014, age-standardised 5-year net survival for superficial spreading melanoma was 95% or higher in Oceania, North America and most European countries, but only 71% in Taiwan. Survival for acral lentiginous melanoma ranged between 66%-95%. Nodular melanoma had the poorest prognosis everywhere. The multivariable analysis of data from registries with complete information on stage and morphology found that sex, age and stage at diagnosis only partially explain the higher risk of death for nodular and acral lentiginous subtypes. Conclusions: This study provides the broadest picture of distribution and population-based survival trends for the main morphological sub-types of cutaneous melanoma in 59 countries. The poorer prognosis for nodular and acral lentiginous melanomas, more frequent in Asia and Latin America, suggests the need for health policies aimed at specific populations to improve awareness, early diagnosis and access to treatment.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Morrison, Dr David
Authors: Di Carlo, V., Stiller, C. A., Eisemann, N., Bordoni, A., Matz, M., Curado, M. P., Daubisse‐Marliac, L., Valkov, M., Bulliard, J.‐L., Morrison, D., Johnson, C., Girardi, F., Marcos‐Gragera, R., Šekerija, M., Larønningen, S., Sirri, E., Coleman, M. P., Allemani, C., and CONCORD Working Group, .
College/School:College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Public Health
Journal Name:British Journal of Dermatology
Publisher:Wiley
ISSN:0007-0963
ISSN (Online):1365-2133
Published Online:29 March 2022
Copyright Holders:Copyright © 2022 The Authors
First Published:First published in British Journal of Dermatology 187(3): 364-380
Publisher Policy:Reproduced under a Creative Commons License

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