Melanoma survival in the United States, 1992 to 2005

Abstract

Background: Population-based data on melanoma survival are important for understanding the impact of demographic and clinical factors on prognosis.

Objective: We describe melanoma survival by age, sex, race/ethnicity, stage, depth, histology, and site.

Methods: Using Surveillance, Epidemiology, and End Results data, we calculated unadjusted cause-specific survival up to 10 years from diagnosis for 68,495 first primary cases of melanoma diagnosed from 1992 to 2005. Cox multivariate analysis was performed for 5-year survival. Data from 1992 to 2001 were divided into 3 time periods to compare stage distribution and differences in stage-specific 5-year survival over time.

Results: Melanomas that had metastasized (distant stage) or were thicker than 4.00 mm had a poor prognosis (5-year survival: 15.7% and 56.6%). The 5-year survival for men was 86.8% and for persons given the diagnosis at age 65 years or older was 83.2%, varying by stage at diagnosis. Scalp/neck melanoma had lower 5-year survival (82.6%) than other anatomic sites; unspecified/overlapping lesions had the least favorable prognosis (41.5%). Nodular and acral lentiginous melanomas had the poorest 5-year survival among histologic subtypes (69.4% and 81.2%, respectively). Survival differences by race/ethnicity were observed in the unadjusted survival, but nonsignificant in the multivariate analysis. Overall 5-year melanoma survival increased from 87.7% to 90.1% for melanomas diagnosed in 1992 through 1995 compared with 1999 through 2001, and this change was not clearly associated with a shift toward localized diagnosis.

Limitations: Prognostic factors included in revised melanoma staging guidelines were not available for all study years and were not examined.

Conclusions: Poorer survival from melanoma was observed among those given the diagnosis at late stage and older age. Improvements in survival over time have been minimal. Although newly available therapies may impact survival, prevention and early detection are relevant to melanoma-specific survival.

Fig 1

Unadjusted Kaplan-Meier melanoma-specific survival curve by age at diagnosis, Surveillance, Epidemiology, and End Results-13, 1992 to 2005.

Fig 2

Unadjusted Kaplan-Meier melanoma-specific survival curves by stage (A), depth (B), histology (C), and anatomic site (D), Surveillance, Epidemiology, and End Results-13, 1992 to 2005. NOS, Not otherwise specified.