Immunosuppression is an independent prognostic factor associated with aggressive tumor behavior in cutaneous melanoma

• Published in: Journal of the American Academy of Dermatology 2015-09, Vol.73 (3), p.461-466
• Main Authors: Donahue, Tracy, MD, Lee, Christina Y., BA, Sanghvi, Asmi, BS, Obregon, Roxana, BA, Sidiropoulos, Michael, MD, Cooper, Chelsea, BA, Merkel, Emily A., BA, Yélamos, Oriol, MD, Ferris, Laura, MD, PhD, Gerami, Pedram, MD
• Format: Article
• Language: English
• Subjects: ABCDE criteria; Adult; age; Age Factors; Aged; Analysis of Variance; Case-Control Studies; Dermatology; dysplastic nevus syndrome; Dysplastic Nevus Syndrome - immunology; Dysplastic Nevus Syndrome - mortality; Dysplastic Nevus Syndrome - pathology; Female; Humans; Immunocompromised Host; immunosuppression; Immunosuppression Therapy; Immunosuppressive Agents - adverse effects; Immunosuppressive Agents - therapeutic use; Male; melanoma; Melanoma - immunology; Melanoma - mortality; Melanoma - pathology; Melanoma, Cutaneous Malignant; metastatic melanoma; Middle Aged; Multivariate Analysis; Neoplasm Invasiveness - pathology; Neoplasm Staging; Predictive Value of Tests; Prognosis; Retrospective Studies; Risk Assessment; Skin Neoplasms - immunology; Skin Neoplasms - mortality; Skin Neoplasms - pathology; Statistics, Nonparametric; Survival Analysis
• ISSN: 0190-9622; 1097-6787
• DOI: 10.1016/j.jaad.2015.06.052

Background A number of factors other than those identified by the American Joint Committee on Cancer (AJCC) may have prognostic significance in the evaluation of melanoma. Objective We sought to evaluate commonly recorded clinical features potentially associated with aggressive melanoma. Methods We conducted a retrospective case-control study. We included patients given a diagnosis of cutaneous melanoma with at least 5 years of follow-up or documented metastases. Patients were divided into nonaggressive and aggressive groups. Univariate and multivariate statistical analyses were performed to evaluate the association of multiple clinical and histologic parameters and metastases. Results We included 141 patients. Significant prognostic factors in univariate analysis associated with nonaggressive disease included history of dysplastic nevus syndrome and ABCDE criteria. Significant factors in univariate analysis associated with aggressive disease included age and immunosuppression. Only age and immunosuppression remained significant in multivariate analysis when controlled across statistically significant histologic variables from AJCC. Limitations The study is retrospective and has a small sample size. Conclusion Older patients and those with a history of immunosuppression may be at higher risk for aggressive disease and should be closely monitored after an initial diagnosis of melanoma.