Unlike other preventable cancers for which mortality rates are dropping, melanoma mortality has only recently stabilized owing in large part to the unremitting increases among middle-aged and older white men, for which much attention has been paid. Gamba et al1 now focus our attention on young adults. Concentrating on US individuals from the National Cancer Institute’s Surveillance, Epidemiology, and End Results registry ages 15 to 39 years, they reveal a rather striking disparity: young men experience a 55% difference in melanoma survival compared with young women. There are many notable findings; among these, sharp sex differences in case fatality wherein young men comprise only 40% of all cases but more than 60% of all deaths. The consistency of the effect seen in 18 registries and over 20 years is quite dramatic; within all specific age groups and across all tumor thickness categories, histologic subtypes, and anatomic sites, young men experience a disproportionate burden of melanoma deaths. Similar sex disparities apparently exist in survival by the presence and extent of regional spread of disease. The findings are so consistent that they imply a fundamental biological difference in “male” vs “female” melanoma, at least for a significant fraction of patients. It is notable that the newly diagnosed melanomas were on average thicker and more advanced in men than in women. This leads to the question of whether increased mortality may have arisen from diagnostic challenges such as “missed” deep margins or later diagnosis and delay. Yet even for melanomas deeper than 4 mm, men fared more poorly than women, thereby pointing more in the direction of distinctive biology. Still, prognosis for disease with distant metastasis was essentially equally poor for men and women.
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