Clinical characteristics, management and survival in young adults diagnosed with malignant melanoma: A population-based cohort study

Figures & data

Table I. Clinical characteristics of young adult melanoma patients aged 15–39 years diagnosed between 1997 and 2011 in the Regional Quality Register of Cutaneous Malignant Melanoma of the Uppsala/Örebro Health Care Region, in comparison with older age groups.

	15–39 years n (%)	40–64 years n (%)	≥ 65 years n (%)	p-value
All patients	584 (9.9)	2457 (41.5)	2874 (48.6)
Sex
Female	376 (64.4)	1258 (51.2)	1308 (45.5)	< 0.001
Male	208 (35.6)	1199 (48.8)	1566 (54.5)
Year of diagnosis
1997–2004	299 (51.2)	1118 (45.5)	1257 (43.7)	0.004
2005–2011	285 (48.8)	1339 (54.5)	1617 (56.3)
Anatomic location
Head and neck	52 (8.9)	180 (7.3)	542 (18.9)	< 0.001
Upper extremity	92 (15.8)	461 (18.8)	600 (20.9)
Lower extremity	197 (33.7)	644 (26.2)	519 (18.1)
Trunk	240 (41.1)	1133 (46.1)	1140 (39.7)
Palm, subungual	2 (0.3)	29 (1.2)	58 (2.0)
Unknown primary	1 (0.2)	10 (0.4)	15 (0.5)
Clinical stage
I	448 (80.6)	1742 (74.3)	1497 (54.8)	< 0.001
II	73 (13.1)	443 (18.9)	1039 (38.0)
III	34 (6.1)	138 (5.9)	150 (5.5)
IV	1 (0.2)	21 (0.9)	47 (1.7)
Not available	28	113	141
Histologic subtype
SSM	439 (78.8)	1739 (74.2)	1551 (56.3)	< 0.001
LMM	6 (1.1)	54 (2.3)	204 (7.4)
NM	83 (14.9)	411 (17.5)	775 (28.1)
ALM	4 (0.7)	37 (1.6)	44 (1.6)
Other types	25 (4.5)	103 (4.4)	180 (6.5)
Not available	27	113	120
Clark level
II	208 (38.2)	736 (32.0)	595 (22.5)	< 0.001
III	220 (40.4)	895 (38.9)	762 (28.8)
IV	109 (20.0)	589 (25.6)	1051 (39.7)
V	7 (1.3)	80 (3.5)	239 (9.0)
Not available	40	157	227
Breslow thickness
≤ 1.0 mm	372 (64.9)	1428 (59.2)	1135 (40.4)	< 0.001
1.1–2.0 mm	131 (22.9)	504 (20.9)	563 (20.1)
2.1–4.0 mm	46 (8.0)	282 (11.7)	537 (19.1)
> 4.0 mm	24 (4.2)	197 (8.2)	571 (20.3)
Not available	11	46	68
Ulceration
No	465 (87.2)	1838 (81.3)	1809 (68.7)	< 0.001
Yes	68 (12.8)	423 (18.7)	826 (31.3)
Not available	51	196	239
Regression
No	369 (81.6)	1561 (80.1)	1806 (79.1)	0.409
Yes	83 (18.4)	388 (19.9)	478 (20.9)
Not available	132	508	590

ALM, acral lentiginous melanoma; LMM, lentigo maligna melanoma; NM, nodular melanoma; SSM, superficial spreading melanoma.

Table II. Management and surgical treatment of young adult melanoma patients aged 15–39 years diagnosed between 1997 and 2011 in the Regional Quality Register of Cutaneous Malignant Melanoma of the Uppsala/Örebro Health Care Region, in comparison with older age groups.

	15–39 years n (%)	40–64 years n (%)	≥ 65 years n (%)	p-value
Institution for primary surgery
Primary care^1	312 (53.4)	1196 (48.7)	1038 (36.1)	< 0.001
Hospital	272 (46.6)	1260 (51.3)	1836 (63.9)
Not available	0	1	0
Type of primary surgery
Excision and suture	552 (94.5)	2261 (92.2)	2468 (85.9)	< 0.001
Skin grafting	4 (0.7)	16 (0.7)	47 (1.6)
Flap surgery	0 (0.0)	6 (0.2)	26 (0.9)
Amputation	0 (0.0)	0 (0.0)	8 (0.3)
Other (incl. biopsy)	28 (4.8)	170 (6.9)	323 (11.2)
Not available	0	4	2
Tumor growth at the line of resection
No	439 (90.0)	1839 (89.6)	2052 (84.8)	< 0.001
Yes	49 (10.0)	213 (10.4)	369 (15.2)
Not available	96	405	453
Adherence to surgical excision guidelines^2
No	41 (10.7)	172 (10.7)	381 (20.9)	< 0.001
Yes	341 (89.3)	1443 (89.3)	1442 (79.1)
Not available	191	796	983
Record of sentinel lymph node biopsy^3
No	301 (78.8)	1247 (75.6)	1619 (83.1)	< 0.001
Yes	81 (21.2)	402 (24.4)	329 (16.9)
Positive sentinel node after sentinel lymph node biopsy^3
No	58 (71.6)	318 (79.1)	256 (77.8)	0.333
Yes	23 (28.4)	84 (20.9)	73 (22.2)

¹Primary care includes private specialist practitioners; ²Recommended surgical excision margins: 10 mm for melanomas ≤ 1.0 mm, and 20 mm for melanomas > 1.0 mm. Surgeries with a total margin greater than or equal to these recommendations were categorized as adherent to the guidelines; ³Data available for patients diagnosed after 2003.

Figure 1. Surgical time intervals for young adult melanoma patients aged 15–39 years in the Regional Quality Register of Cutaneous Malignant Melanoma of the Uppsala/Örebro Health Care Region, in comparison with older age groups. (A) Time between first visit and primary surgery (data available for patients diagnosed between 2009 and 2011, n = 1816). (B) Time between primary and extended surgery (data available for patients diagnosed between 1997 and 2011, n = 6227).

Figure 2. Cumulative relative survival in young adult melanoma patients aged 15–39 years diagnosed between 1997 and 2011 in the Regional Quality Register of Cutaneous Malignant Melanoma of the Uppsala/Örebro Health Care Region, in comparison with older age groups and according to stage at diagnosis.

Table III. Relative excess risk of death in patients with malignant melanoma diagnosed between 1997 and 2011 in the Regional Quality Register of Cutaneous Malignant Melanoma of the Uppsala/Örebro Health Care Region, according to stage at diagnosis.

	Stage II				Stage III
	Crude		Adjusted^1		Crude		Adjusted^1
	RER	95% CI	RER	95% CI	RER	95% CI	RER	95% CI
Age at diagnosis
15–39 years	0.24	0.12–0.51	0.31	0.15–0.66	0.63	0.35–1.14	0.84	0.41–1.71
40–64 years	0.69	0.54–0.88	0.70	0.54–0.90	0.80	0.56–1.14	0.97	0.64–1.47
≥ 65 years	1.00	ref	1.00	ref	1.00	ref	1.00	ref
Year of diagnosis
Per year	0.98	0.95–1.01	0.98	0.95–1.01	0.92	0.89–0.96	0.93	0.88–0.98
Sex
Female	0.70	0.54–0.91	0.76	0.59–0.98	0.88	0.63–1.24	0.85	0.55–1.30
Male	1.00	ref	1.00	ref	1.00	ref	1.00	ref
Anatomic location
Head and neck	1.00	ref	1.00	ref	1.00	ref	1.00	ref
Upper extremity	0.58	0.38–0.87	0.69	0.47–1.02	0.56	0.29–1.09	0.49	0.24–1.02
Lower extremity	0.51	0.34–0.77	0.68	0.45–1.00	0.63	0.35–1.15	0.58	0.29–1.14
Trunk	0.68	0.49–0.95	0.71	0.52–0.99	0.67	0.38–1.20	0.57	0.30–1.09
Palm, subungual	1.06	0.57–1.95	0.92	0.47–1.79	0.37	0.09–1.52	0.26	0.07–0.92
Breslow thickness
≤ 1.0 mm	–	–	–	–	1.00	ref	1.00	ref
1.1–2.0 mm	1.00	ref	1.00	ref	0.58	0.25–1.33	0.72	0.27–1.87
2.1–4.0 mm	1.44	0.87–2.38	1.66	1.09–2.54	0.91	0.43–1.93	1.25	0.53–2.93
> 4.0 mm	3.52	2.18–5.66	3.10	2.07–4.65	1.83	0.91–3.71	1.73	0.75–4.00
Ulceration
No	1.00	ref	1.00	ref	1.00	ref	1.00	ref
Yes	1.71	1.28–2.29	1.83	1.39–2.40	2.57	1.66–3.98	2.14	1.34–3.41

CI, confidence interval; RER, relative excess risk.

¹Adjusted for all other presented variables.