Malignant Melanoma: It Pays to Be a Woman

Jacob Mashiah, MD, Sarah Brenner, MD

Disclosures

Skinmed. 2003;2(3) 

In This Article

Introduction

The rise in incidence and mortality rates for melanoma worldwide is among the highest for all kinds of cancer.[1] Lifetime risk of melanoma in the United States reached 1 in 75 in the year 2000 compared with only 1 in 1500 in 1935.[2]

Differences in these rates between men and women have been reported in many studies.[3,4,5,6,7] Indeed, gender[5,6,7] is one of the accepted prognostic parameters in melanoma, in addition to thickness of the lesion,[3] anatomic location, and presence of ulceration in the primary lesion.[4] In an assessment of the incidence and survival from malignant melanoma in Scotland, from 1979-1998[8] men showed a rise of 303% in incidence, from 3.5 to 10.6 per 100,000, standardized for age, while the rise in women was 187%, from 7 to 13.1 per 100,000. The incidence of tumors less than 1.5 mm in thickness increased the most, especially in women. Comparison of the 5-year survival rate for diagnosis made in 1979 and 1993 revealed a change from 58% to 80% for men and from 74% to 85% for women; the men's mortality rates remained 1.9 per 100,000 per year; mortality among men under age 65 at diagnosis rose from 1.2 to 1.35 per 100,000 per year; women's mortality rates fell from 1.9 to 1.85 per 100,000 per year; and women younger than 65 at diagnosis had a mortality rate of 1.3 that fell to 1.15.

Investigators[9] also reported the incidence and mortality rates for melanoma between 1973 to 1994 in the United States. The incidence for men rose 154.4% (from 6.8 to 17.3 per 100,000 per year) vs. 90.2% for women (from 6.1 to 11.6). From 1990-1994, the incidence rose 6.8% in men and decreased 1.3% in women. Mortality rates rose in men by 48.9%, from 2.4 to 3.5, and in women by 21.4%, from 1.4 to 1.7.

There was a persistent decrease in mortality rates from melanoma for men and women aged 20-44 and for women aged 45-64 years in a US study[10] conducted between 1969 and 1999. Mortality rates and incidence rates were parallel, and a greater increase in incidence among older than younger men was noted. Women showed a similar pattern but with a smaller increase in incidence. Public education on primary and secondary prevention can account for these trends.

Women had better survival in all but four out of 22 epidemiologic studies published between 1977 and 1996,[11] with an increasing advantage that paralleled the Breslow thickness of the primary melanoma. Higher age of the patients, both men and women, was associated with poorer prognosis in the majority of the studies. Women had a better prognosis in all age groups, including premenopausal and post-menopausal groups.

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