Abstract：
BACKGROUND: Previous population-based studies have reported that the majority of melanoma mortality is related to patients with thin (≤1 mm Breslow thickness) melanomas. The aim of the present study was to evaluate the relative proportion of melanoma-specific deaths across all stages of melanoma at diagnosis over the past 20 y in the United States.
METHODS: A review of all cutaneous melanoma cases in the US Surveillance, Epidemiology, and End Results registry from 2004 to 2020 was performed. Breslow thickness was categorized as thin (≤1.0 mm), intermediate (>1-4 mm), or thick (>4 mm). All-cause deaths and melanoma-specific deaths were compared across tumor thickness and stage groups at diagnosis. Survival analysis was performed with nonmelanoma deaths considered as a competing risk to estimate the cumulative incidence of melanoma-specific death.
RESULTS: Most melanoma deaths occurred in patients who initially presented with local disease (53%) compared to regional (36%) or distant (11%) disease (P < 0.001). However, most (66%) of the melanoma-specific deaths in patients who presented with localized disease were in those with intermediate or thick (i.e., Breslow thickness >1.0 mm) primary tumors compared to those with thin melanomas (34%). The cumulative incidence of melanoma-specific death at 10 y in patients with localized thin melanomas at the time of diagnosis was 2.6% (95% confidence intervals 2.5%-2.7%).
CONCLUSIONS: The public health burden in terms of melanoma-specific mortality is related to patients with tumors >1 mm Breslow thickness, many of whom have regional and distant metastatic disease at the time of diagnosis, not patients with thin melanomas.
METHODS: A review of all cutaneous melanoma cases in the US Surveillance, Epidemiology, and End Results registry from 2004 to 2020 was performed. Breslow thickness was categorized as thin (≤1.0 mm), intermediate (>1-4 mm), or thick (>4 mm). All-cause deaths and melanoma-specific deaths were compared across tumor thickness and stage groups at diagnosis. Survival analysis was performed with nonmelanoma deaths considered as a competing risk to estimate the cumulative incidence of melanoma-specific death.
RESULTS: Most melanoma deaths occurred in patients who initially presented with local disease (53%) compared to regional (36%) or distant (11%) disease (P < 0.001). However, most (66%) of the melanoma-specific deaths in patients who presented with localized disease were in those with intermediate or thick (i.e., Breslow thickness >1.0 mm) primary tumors compared to those with thin melanomas (34%). The cumulative incidence of melanoma-specific death at 10 y in patients with localized thin melanomas at the time of diagnosis was 2.6% (95% confidence intervals 2.5%-2.7%).
CONCLUSIONS: The public health burden in terms of melanoma-specific mortality is related to patients with tumors >1 mm Breslow thickness, many of whom have regional and distant metastatic disease at the time of diagnosis, not patients with thin melanomas.
摘要：
背景：先前基于人群的研究报道，大多数黑色素瘤死亡率与薄型（≤1mmBreslow厚度）黑色素瘤患者有关。本研究的目的是评估在过去20年中在美国诊断的黑色素瘤的所有阶段中黑色素瘤特异性死亡的相对比例。
方法：对美国监测中所有皮肤黑色素瘤病例的回顾，流行病学,并进行了2004年至2020年的最终结果登记。Breslow厚度被归类为薄（≤1.0毫米），中间（>1-4毫米），或厚（>4毫米）。在诊断时，比较了肿瘤厚度和阶段组的全因死亡和黑色素瘤特异性死亡。对被认为是竞争风险的非黑色素瘤死亡进行生存分析，以估计黑色素瘤特异性死亡的累积发生率。
结果：大多数黑色素瘤死亡发生在最初出现局部疾病（53%）的患者中，与局部疾病（36%）或远处疾病（11%）相比（P<0.001）。然而,出现局部疾病的患者中，大多数（66％）的黑色素瘤特异性死亡是中度或重度（即，Breslow厚度>1.0mm）原发性肿瘤与薄黑色素瘤（34％）相比。诊断时，局部薄型黑色素瘤患者在10年时黑色素瘤特异性死亡的累积发生率为2.6％（95％置信区间为2.5％-2.7％）。
结论：就黑色素瘤特异性死亡率而言，公共卫生负担与肿瘤厚度>1mmBreslow患者有关，其中许多人在诊断时患有区域性和远处转移性疾病，不是薄薄的黑色素瘤患者。
方法：对美国监测中所有皮肤黑色素瘤病例的回顾，流行病学,并进行了2004年至2020年的最终结果登记。Breslow厚度被归类为薄（≤1.0毫米），中间（>1-4毫米），或厚（>4毫米）。在诊断时，比较了肿瘤厚度和阶段组的全因死亡和黑色素瘤特异性死亡。对被认为是竞争风险的非黑色素瘤死亡进行生存分析，以估计黑色素瘤特异性死亡的累积发生率。
结果：大多数黑色素瘤死亡发生在最初出现局部疾病（53%）的患者中，与局部疾病（36%）或远处疾病（11%）相比（P<0.001）。然而,出现局部疾病的患者中，大多数（66％）的黑色素瘤特异性死亡是中度或重度（即，Breslow厚度>1.0mm）原发性肿瘤与薄黑色素瘤（34％）相比。诊断时，局部薄型黑色素瘤患者在10年时黑色素瘤特异性死亡的累积发生率为2.6％（95％置信区间为2.5％-2.7％）。
结论：就黑色素瘤特异性死亡率而言，公共卫生负担与肿瘤厚度>1mmBreslow患者有关，其中许多人在诊断时患有区域性和远处转移性疾病，不是薄薄的黑色素瘤患者。
