Young Men at Higher Risk for Mortality From Invasive Cutaneous Melanoma Than Young Women
Young Men at Higher Risk for Mortality From Invasive Cutaneous ... Dermatology Advisor
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Pediatric and Adolescent Melanoma: Gender Differences and Impact on Survival
A recent study published in the Journal of the American Academy of Dermatology has found that pediatric and adolescent boys with primary invasive cutaneous melanoma have more aggressive pathologic features, which increase their risk for mortality compared to girls in the same age group.
Background
Melanoma is a rare diagnosis in patients younger than 20 years old, accounting for less than 0.4% of all new cases. However, survival rates among pediatric patients are strongly associated with the initial staging of melanoma. Previous studies on pediatric melanoma have not focused on the impact of sex assigned at birth on clinical presentation or outcome. Therefore, this study aimed to characterize the presentation and survival of pediatric and adolescent patients with melanoma, stratified by sex assigned at birth.
Methods
This retrospective cohort study utilized data from the National Cancer Database (NCDB) from 2004 to 2018. The study included 4,645 pediatric and adolescent patients (infancy to 21 years old) with primary invasive cutaneous melanoma. Patients with multiple malignancies or melanoma in situ were excluded from the analysis.
Results
Among patients with primary invasive cutaneous melanoma, 63.4% were girls or women. Girls and women had a higher proportion of stage I disease compared to boys and men (67.8% vs 53.6%). On the other hand, boys and men had a higher percentage of stage II (15.9% vs 12.3%), stage III (27.1% vs 18.3%), and stage IV (3.3% vs 1.6%) disease. These findings indicate a significant association between sex and stage at diagnosis (P < .001). The most common primary site for both sexes was the trunk, and the most common histologic subtype was superficial spreading melanoma.
Boys and men had statistically higher rates of regional lymph node positivity (27.9% vs 18.1%) and ulceration (17.1% vs 11.4%) compared to girls and women. The median Breslow depth was also higher for boys and men (1.05 mm; interquartile range [IQR], 0.50-2.31) than for girls and women (0.80 mm; IQR, 0.40-1.67; both P < .001).
Survival Rates
The 5-year overall survival rate was higher for girls and women than for boys and men (95.9% vs 92.0%; P < .001), as was the overall 10-year survival rate (93.9% vs 86.7%; P < .001). Male sex was independently associated with an increased risk of mortality (adjusted hazard ratio, 1.57; 95% CI, 1.32-1.86; P < .001) after adjusting for confounding factors such as age, primary site, stage at diagnosis, and histologic subtype.
Subanalysis
In the subanalysis of patients aged 15 to 21 years, boys and men had higher rates of nodular melanoma, melanoma in a congenital melanocytic nevus, and spitzoid, epithelioid, and spindle cell melanoma compared to girls and women (all P < .001). However, girls and women had a higher rate of superficial spreading melanoma compared to boys and men (35.5% vs 32.6%). No significant relationship was found between sex and histologic subtype among patients aged 0 to 14 years.
Limitations
This study has several limitations, including its retrospective nature, a large percentage of patients with an unspecified histologic subtype, relatively low mortality rates among children and adolescents, and limited data on disease-specific survival and comorbid conditions in the National Cancer Database (NCDB).
Conclusion
The study concluded that males with pediatric and adolescent melanoma exhibit more aggressive pathologic features, including greater Breslow thickness and higher ulceration and lymph node positivity rates. Male gender was independently associated with worse overall survival in adolescents but not in pediatrics.
References:
Fernandez JM, Koblinski JE, Dahak S, Curiel-Lewandrowski C, Thiede R. Gender differences in pediatric and adolescent melanoma: a retrospective analysis of 4645 cases. J Am Acad Dermatol. Published online October 4, 2023. doi:10.1016/j.jaad.2023.09.049
SDGs, Targets, and Indicators Analysis
1. Which SDGs are addressed or connected to the issues highlighted in the article?
- SDG 3: Good Health and Well-being
- SDG 5: Gender Equality
The article discusses the impact of sex assigned at birth on the clinical presentation and outcome of pediatric and adolescent patients with melanoma. This addresses the goal of ensuring good health and well-being (SDG 3) for all individuals, as well as promoting gender equality (SDG 5) by examining the differences in melanoma characteristics between boys/men and girls/women.
2. What specific targets under those SDGs can be identified based on the article’s content?
- Target 3.4: By 2030, reduce by one-third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being.
- Target 5.1: End all forms of discrimination against all women and girls everywhere.
The article highlights the differences in clinical presentation and outcome between boys/men and girls/women with melanoma, indicating a potential need for targeted prevention and treatment strategies to reduce premature mortality (Target 3.4). Additionally, the findings suggest the presence of gender-based discrimination in healthcare outcomes, emphasizing the importance of ending such discrimination (Target 5.1).
3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?
- Indicator for Target 3.4: Mortality rate from melanoma among pediatric and adolescent patients.
- Indicator for Target 5.1: Difference in overall survival rates between boys/men and girls/women with melanoma.
The article provides data on mortality rates and overall survival rates among pediatric and adolescent patients with melanoma, which can be used as indicators to measure progress towards reducing premature mortality (Target 3.4) and addressing gender-based disparities in healthcare outcomes (Target 5.1).
SDGs, Targets, and Indicators Table
| SDGs | Targets | Indicators |
|---|---|---|
| SDG 3: Good Health and Well-being | Target 3.4: By 2030, reduce by one-third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being. | Mortality rate from melanoma among pediatric and adolescent patients. |
| SDG 5: Gender Equality | Target 5.1: End all forms of discrimination against all women and girls everywhere. | Difference in overall survival rates between boys/men and girls/women with melanoma. |
Behold! This splendid article springs forth from the wellspring of knowledge, shaped by a wondrous proprietary AI technology that delved into a vast ocean of data, illuminating the path towards the Sustainable Development Goals. Remember that all rights are reserved by SDG Investors LLC, empowering us to champion progress together.
Source: dermatologyadvisor.com
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