Lo Serigne N, Williams Gabrielle J, Cust Anne E, Ollila David W, Varey Alexander H R, Ch'ng Sydney, Scolyer Richard A, Thompson John F
Melanoma Institute Australia, The University of Sydney, Sydney, Australia.
Faculty of Health and Medicine, The University of Sydney, Sydney, Australia.
JAMA Dermatol. 2025 Feb 1;161(2):167-174. doi: 10.1001/jamadermatol.2024.4900.
Most patients who present with primary cutaneous melanomas have thin tumors (≤1.0 mm in Breslow thickness, ie, pT1a and pT1b). Although their prognosis is generally considered to be excellent, there is limited precise information on the association of risk of death with specific Breslow measurements in thin lesions.
To assess the relative effect of a 0.8-mm Breslow thickness threshold with respect to the incidence of both melanoma-related and nonmelanoma-related death.
DESIGN, SETTING, AND PARTICIPANTS: Registry data for all Australians diagnosed with thin invasive primary melanomas between 1982 and 2014 were analyzed. Data were extracted from all 8 Australian state and territory population-based cancer registries. Dates and causes of death were obtained from the Australian National Death Index. Adults diagnosed with a first invasive primary melanoma of 1.0 mm or smaller in thickness were included.
First invasive primary melanoma between 1982 and 2014.
The primary outcomes were melanoma-related deaths and nonmelanoma-related deaths. Competing-risk regression analyses and cause-specific analyses were performed to investigate the relationships between Breslow thickness subcategory (<0.8 mm versus ≥0.8 mm by 0.1-mm increments) and the primary outcomes.
Overall, a cohort of 144 447 participants was included. The median (range) age was 56 (18-101) years and 78 014 (54.0%) were men. Median (IQR) follow-up was 15.0 (9.5-23.3) years. Crude incidence rates of melanoma-related death 20 years after diagnosis were 6.3% (95% CI, 6.1%-6.5%) for the whole cohort, 6.0% (95% CI, 5.7%-6.2%) for tumors smaller than 0.8 mm, and 12.0% (95% CI, 11.4%-12.6%) for tumors 0.8 to 1.0 mm. The corresponding 20-year melanoma-specific survival rates were 91.9% (95% CI, 91.6%-92.1%), 94.2% (95% CI, 94.0%-94.4%), and 87.8% (95% CI, 87.3%-88.3%), respectively. On multivariable analysis, tumor thickness of 0.8 to 1.0 mm was significantly associated with both a greater absolute risk of melanoma-related death (subdistribution hazard ratio, 2.92; 95% CI, 2.74-3.12) and a greater rate of melanoma-related death (hazard ratio, 2.98; 95% CI, 2.79-3.18) than thinner tumors (<0.8 mm). Risk of death from nonmelanoma-related causes was not associated with Breslow thickness.
In this study, the risk of melanoma-related death increased significantly for patients with primary tumors of 0.8 to 1.0 mm in thickness. The risk of death from nonmelanoma-ralated causes was similar across Breslow thicknesses of 0.1 to 1.0 mm. This analysis suggests that a 0.8-mm threshold for guiding the care of patients with thin primary melanomas.
大多数原发性皮肤黑色素瘤患者的肿瘤较薄（Breslow厚度≤1.0 mm，即pT1a和pT1b）。尽管其预后通常被认为极佳，但关于薄病灶中特定Breslow测量值与死亡风险之间关联的精确信息有限。
评估0.8 mm Breslow厚度阈值对黑色素瘤相关死亡和非黑色素瘤相关死亡发生率的相对影响。
设计、设置和参与者：分析了1982年至2014年间所有被诊断为薄浸润性原发性黑色素瘤的澳大利亚人的登记数据。数据从澳大利亚所有8个州和地区基于人群的癌症登记处提取。死亡日期和原因从澳大利亚国家死亡指数获得。纳入诊断为厚度1.0 mm或更小的首例浸润性原发性黑色素瘤的成年人。
1982年至2014年间的首例浸润性原发性黑色素瘤。
主要结局为黑色素瘤相关死亡和非黑色素瘤相关死亡。进行竞争风险回归分析和特定病因分析，以研究Breslow厚度亚组（<0.8 mm与≥0.8 mm，以0.1 mm递增）与主要结局之间的关系。
总体而言，纳入了144447名参与者。中位（范围）年龄为56（18 - 101）岁，78014名（54.0%）为男性。中位（IQR）随访时间为15.0（9.5 - 23.3）年。诊断后20年黑色素瘤相关死亡的粗发病率在整个队列中为6.3%（95%CI，6.1% - 6.5%），小于0.8 mm的肿瘤为6.0%（95%CI，5.7% - 6.2%），0.8至1.0 mm的肿瘤为12.0%（95%CI，11.4% - 12.6%）。相应的20年黑色素瘤特异性生存率分别为91.9%（95%CI，91.6% - 92.1%）、94.2%（95%CI，94.0% - 94.4%）和87.8%（95%CI，87.3% - 88.3%）。多变量分析显示，与较薄肿瘤（<0.8 mm）相比，0.8至1.0 mm的肿瘤厚度与黑色素瘤相关死亡的绝对风险更高（亚分布风险比，2.92；95%CI，2.74 - 3.12）以及黑色素瘤相关死亡发生率更高（风险比，2.98；95%CI，2.79 - 3.18）均显著相关。非黑色素瘤相关病因导致的死亡风险与Breslow厚度无关。
在本研究中，厚度为0.8至1.0 mm的原发性肿瘤患者黑色素瘤相关死亡风险显著增加。在Breslow厚度为0.1至1.0 mm范围内，非黑色素瘤相关病因导致的死亡风险相似。该分析表明，0.8 mm阈值可用于指导薄原发性黑色素瘤患者的治疗。
