Survival in melanoma depends on the thickness of the tumour

Researchers from the University of Sydney have found a significantly increased risk of melanoma death in patients with primary tumours between 0.8 and 1.0 millimeters thick compared to those with thinner tumors.

According to long-term population-based studies, small-thickness cutaneous melanomas, commonly defined as being 1.0 millimeter or less in thickness, account for up to 72% of all melanomas. Australia, which has the highest incidence of melanoma in the world, has maintained extensive cancer registries for decades, providing a unique basis for widespread detection and regular monitoring of thin melanomas.

Knowledge of how subtle changes in thickness correlate with patient survival may provide arguments for clinical judgement as part of long-term monitoring and treatment.

Melanoma is the most invasive type of skin cancer with the highest risk of death. Although it is a serious skin cancer, it is highly treatable if detected at an early stage. Prevention and early treatment are crucial, especially in people with lighter skin, blonde or red hair, and blue eyes. Melanoma arises from skin cells called melanocytes. These cells produce melanin, a dark pigment that gives the skin its colour. Most melanomas are black or brown, but some are pink, red, purple or skin coloured.

In the study, ‘Risk of death from melanoma and other causes in patients with thin cutaneous melanoma,’ published in JAMA Dermatology, researchers analyzed population-based registries in Australia from 1982 to 2014.

All patients were diagnosed with invasive melanomas of 1.0 millimeters or less in thickness. Data included age, gender, anatomical location and records detailing death.

The researchers conducted cause and competing risk analyses to determine rates of melanoma-related and non-melanoma-related mortality over the long term.  Breslow melanoma thickness measurements in 0.1 millimetre increments were considered to assess changes in risk.

Of the 144,447 patients included in the study, the overall 20-year melanoma survival rate was 91.9%, but survival rates differed significantly between groups depending on tumour thickness. Among patients with tumours less than 0.8 mm thick, 94.2% survived, and among patients with tumours 0.8-1.0 mm thick, 87.8% survived.

The results support the use of a Breslow thickness threshold of 0.8 mm to differentiate between high- and low-risk patients, supporting its continued inclusion in the American Joint Committee on Cancer staging criteria. The results also emphasize the need for long-term follow-up of this patient population, as melanoma mortality continues to accumulate beyond 20 years.

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Published: 16.12.2024

Updated: 16.12.2024

Medical author, Medical editor:

Stepan Yuk

Medical expert:

PhD. Olexandr Voznyak