Survival outcomes among adolescents and young adults (AYAs) with advanced melanoma were much worse than in older adults. These findings from a population-based study were published in the Journal of the American Academy of Dermatology.
Melanoma is one of the most common cancers among AYAs, and advanced disease is associated with poor survival. To date, data about mortality risk factors among young populations remain limited.
Data for this study were sourced from 81,597 patients in the California Cancer Registry (CCR) with cutaneous melanoma diagnosed between 2004 and 2015 and evaluated for survival through 2017. Risk factors for mortality were evaluated on the basis of age.
The cohorts of 12,505 AYAs aged 15 to 39 years and 69,092 older adults aged 40 to 64 years comprised 62.6% and 44.5% women or girls and 75.9% and 82.5% were White, respectively.
Compared with older adults, the AYAs developed in situ melanoma (P <.001) or ulceration (P =.03) less frequently but were more likely to have tumors with mitotic activity (P <.001).
All-cause deaths occurred in 599 and 5824 patients in the AYA and older adult groups, respectively, and melanoma-specific death in 459 and 3023, respectively.
Referencing stage I disease, mortality risk was higher in AYAs compared with older adults with stage IV (adjusted hazard ratio [aHR], 20.39 vs 10.79), stage III (aHR, 3.31 vs 3.18), and stage II (aHR, 2.08 vs 1.53) disease.
Among AYAs, all-cause mortality also associated with tumor thickness 4.00 mm and thicker (aHR, 5.58), 2.00 to less than 4.00 mm (aHR, 3.68), or 1.00 to less than 2.00 mm (aHR, 3.27) compared with less than 1.00 mm; ulceration (aHR, 1.73); and male sex (aHR, 1.43).
This study was limited by not having access to data about family history or genetic susceptibility.
These data indicated that mortality risk was greater for adolescents and young adults compared with older adults at every stage of advanced disease.
Wojcik KY, Hawkins M, Anderson-Mellies A, et al. Melanoma survival by age group: population-based disparities for adolescent and young adult patients by stage, tumor thickness, and insurance type. J Am Acad Dermatol. Published online January 4, 2023. doi:10.1016/j.jaad.2022.10.063