Survival of cutaneous melanoma based on sex, age, and stage in the United States, 1992-2011

Abstract

Women diagnosed with cutaneous melanoma have a survival advantage compared to men, which has been hypothesized to be due to difference in behavior and/or biology (sex hormones). It remains controversial whether this advantage is dependent on age or stage of disease. We sought to compare melanoma-specific survival between females in pre, peri, and postmenopausal age groups to males in the same age group, adjusting for stage of disease. This is a retrospective population-based cohort study using the Surveillance, Epidemiology, and End Results (SEER) database. Patients diagnosed from 1 January 1992 through 31 January 2011 with primary invasive cutaneous melanoma were included in our cohort. Melanoma-specific survival was the main outcome studied. Of the 106,511 subjects that were included, 45% were female. Females in all age groups (18-45, 46-54, and ≥55) with localized and regional disease, were less likely to die from melanoma compared to males in the same age group. Among patients with localized and regional disease, the relative risk of death due to melanoma increased with advancing age at diagnosis; this increase was more pronounced among females than males. In contrast, we observed no female survival advantage among patients with distant disease and no effect of age on relative risk of death from melanoma. Females with localized and regional melanoma have a decreased risk of death compared to males within all age groups. Our data show no differences in survival between men and women with metastatic melanoma, indicating that the influence of sex on survival is limited to early stage disease but not confined to pre or perimenopausal age groups.

Keywords: Cutaneous melanoma; female; male; stage; survival.

Figure 1

Relative risk of death due to melanoma by sex and age at diagnosis, according to disease stage. In each figure, 40‐year‐old females are the reference (relative risk of 1). (A) localized; (B) regional; (C) distant.

Figure 2

Melanoma‐specific survival according to sex, stage, and age at diagnosis. Each patient's full follow‐up was considered, however, the figures have been truncated at 15 years after diagnosis. (A) 18–45 years at diagnosis; (B) 46–54 years at diagnosis; (C) ≥55 years at diagnosis).

Figure 3

Conditional melanoma‐specific survival according to sex, stage, and age at diagnosis. Each patient's full follow‐up was considered, however, the figures have been truncated at 15 years after diagnosis. (A) 18–45 years at diagnosis and surviving 1 year (n = 25,508 localized, n = 2342 regional, and n = 279 distant); (B) 46–54 years at diagnosis and surviving 1 year (n = 16,970 localized, n = 1679 regional, and n = 265 distant); (C) ≥55 years at diagnosis and surviving 1 year (n = 44,209 localized, n = 5555 regional, and n = 883 distant); (D) 18–45 years at diagnosis and surviving 3 years (n = 22,613 localized, n = 1754 regional, and n = 122 distant); (E) 46–54 years at diagnosis and surviving 3 years (n = 14,491 localized, n = 1188 regional, and n = 124 distant); (F) ≥55 years at diagnosis and surviving 3 years (n = 34,741 localized, n = 3316 regional, and n = 353 distant); (G) 18–45 years at diagnosis and surviving 5 years (n = 19,641 localized, n = 1376 regional, and n = 87 distant); (H) 46–54 years at diagnosis and surviving 5 years (n = 12,131 localized, n = 931 regional, and n = 79 distant); (I) ≥55 years at diagnosis and surviving 5 years (n = 26,625 localized, n = 2301 regional, and n = 200 distant).