Hensin Tsao, MD, PhD

Higher incidence of ulcerated melanoma in older men may explain their higher associated mortality.

One of the great mysteries in melanoma pathology is the etiology of ulceration. Clinically, the presence of ulceration has consistently been shown to be associated with lower survival rates compared with similar but nonulcerated lesions. In a recent analysis, investigators attempted to use the National Cancer Institute's Surveillance, Epidemiology, and End Results database to tease out the effects of ulceration in a large cohort of melanomas.

The researchers compared tumors of differing depth (range, ≤1.00 mm to ≥4.01 mm) in 5106 patients and stratified the results by sex (3206 men) and age (younger, 10–39 years; older, 40–84 years). The incidence of ulceration was unaffected by tumor depth in younger men and older women. In younger women, ulceration incidence decreased in tumors of greatest thickness (from .13 to .08 per 100,000), but the change was without statistical significance. A statistically significant rise in ulceration incidence was observed with increasing thickness, however, among older men (from 1.02 per 100,000 for the thinnest tumors to 1.38 per 100,000 for the thickest).

Citation(s):

Richardson BS et al. The age-specific effect modification of male sex for ulcerated cutaneous melanoma. JAMA Dermatol 2014 Mar 5; [e-pub ahead of print].