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Original Investigation |

The Age-Specific Effect Modification of Male Sex for Ulcerated Cutaneous Melanoma

Blakely S. Richardson, DO1; William F. Anderson, MD, MPH2; Jill S. Barnholtz-Sloan, PhD3; Margaret A. Tucker, MD4; Meg R. Gerstenblith, MD1
[+] Author Affiliations
1Department of Dermatology, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, Ohio
2Biostatistics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
3Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
4Human Genetics Program, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
JAMA Dermatol. 2014;150(5):522-525. doi:10.1001/jamadermatol.2013.7127.
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Importance  Tumor ulceration is an important prognostic factor for cutaneous melanoma (CM). Previous studies demonstrated that the proportion of ulcerated to nonulcerated CM rose with increasing tumor depth. These frequency-based studies, however, were not adjusted for the population at risk.

Objective  To determine the absolute incidence of ulcerated CM by tumor depth, stratified by sex and age at diagnosis.

Design, Setting, and Participants  We compared ulcerated CM by tumor thicknesses (≤1.00, 1.01-2.00, 2.01-4.00, and ≥4.01 mm), stratified by sex among younger (10-39 years) and older (40-84 years) non-Hispanic whites in the National Cancer Institute’s Surveillance, Epidemiology, and End Results database from 2004 through 2008. Types of CM included superficial spreading, nodular, and unclassified in 5106 cases among 3206 men and 1900 women.

Main Outcomes and Measures  Incidence of ulcerated CM by tumor depth for younger and older men and women.

Results  The incidence of tumor ulceration was stable across all tumor depths among younger men and older women. Among younger women, it declined for the thickest lesions (0.08 per 100 000 for tumor depth ≥4.01 mm), although the trend was not statistically significant. In contrast, among older men, there was a statistically significant increase in ulceration for CM with a depth of approximately 1.4 per 100 000 for tumor depth of 2.00 mm or thicker.

Conclusions and Relevance  Male sex is an age-specific effect modifier for ulcerated CM by tumor depth. Future studies and staging guidelines should consider the interaction among CM ulceration, thickness, sex, and age at diagnosis.

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Figure.
Linear Trend in the Logarithm of the IRR for Ulcerated Cutaneous Melanomas

We assessed the linear trend for ulcerated cutaneous melanomas between older and younger men (A) and between older and younger women (B) by category of tumor depth. The null hypothesis of no trend was rejected at the α = .05 level. A, P = .01 for IRR trend. B, P = .34 for IRR trend. IRR indicates incidence rate ratio.

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