Acta Dermato-Venereologica 99-12CompleteContent | Page 23

1154 INVESTIGATIVE REPORT Solar Lentigines are Associated with Better Outcome in Cutaneous Melanoma Vivien MARASIGAN 1# , Canan GÜVENÇ 1# , Joost J. VAN DEN OORD 2 , Marguerite STAS 3 , Veerle BOECXSTAENS 3 , Oliver BECHTER 4 , Pascal WOLTER 5 , Diether LAMBRECHTS 6,7 and Marjan GARMYN 1 Department of Dermatology, 2 Department of imaging and pathology, Translational cell and tissue research, 3 Department of Surgical Oncology and 4 Department of General Medical Oncology, University Hospitals Leuven, Leuven, 5 Department of Hematology and Oncology, CHR Verviers East Belgium, 6 VIB Center for Cancer Biology, VIB, and 7 Laboratory for Translational Genetics, Department of Human Genetics, KU Leuven, Leuven, Belgium # These authors contributed equally. 1 The rising incidence of cutaneous melanoma and its stable high mortality rates despite innovative cancer care, require better prediction of the clinical outcome. In a large cutaneous melanoma population we explo- red whether the known clinical risk factors for mela- noma susceptibility (naevus phenotype, phototype, family and personal history of melanoma and sun da- mage) affect melanoma outcomes. A total of 1,530 melanoma patients were included. Multivariable ana- lysis adjusted for age, sex, melanoma stage, localiza- tion and subtype showed that familial melanoma, solar lentigines on head and neck, the back of hands, arms and shoulders were associated with a better relapse free survival. The presence of atypical naevi was as- sociated with an increased risk of relapse. After Bon- ferroni correction, the correlation between presence of solar lentigines on the back of the hands and arms remained the most robust and significant prognostic factor for the relapse-free survival in cutaneous mela- noma patients. Key words: melanoma, clinical risk factors, melanoma suscepti- bility, outcome, chronic cumulative photodamage. Accepted Jul 17, 2019; E-published Jul 17, 2019 Acta Derm Venereol 2019; 99: 1154–1159. Corr: Marjan Garmyn, MD, PhD, Department of Dermatology, University Hospitals Leuven, Herestraat 49, BE-3000 Leuven, Belgium. E-mail: mar- [email protected] C utaneous melanoma (CM) is the most common lethal skin disease worldwide, affecting mainly Caucasians (1). The rising incidence and stable high mortality rates of CM, despite continuously improving therapies, calls for a better prediction of its clinical outcome. The American Joint Committee on Cancer (AJCC) for melanoma staging identified clinico-histopathological risk factors that influence the melanoma outcome, in- cluding Breslow thickness, mitosis, ulceration, sentinel node status, regional macrometastatic disease and distant metastatic disease (2). Age, sex, localization and subtype have also been associated with the melanoma outcome, although these are not yet implemented in the staging criteria (3). In addition, several risk factors have been linked to melanoma susceptibility, including a high count of common naevi, presence of atypical naevi, sun doi: 10.2340/00015555-3270 Acta Derm Venereol 2019; 99: 1154–1159 SIGNIFICANCE This explorative study in a large carefully phenotyped me- lanoma population demonstrates that melanoma suscepti- bility risk factors, indicative of chronic photodamage, are correlated with clinical outcome. The presence of solar len- tigines on the back of the hands and arms is associated with a better relapse free survival. This finding may offer clinicians an additional tool to risk stratify their melanoma patients. exposure, low phototype, freckles, actinic damage, and personal and family history of melanoma (4–7). Previous studies have investigated associations of in- dividual melanoma susceptibility risk factors, including sun exposure (8–11), family (12) or personal history of melanoma (13), and naevus phenotype (14, 15) with melanoma outcome. Most of these studies are based on questionnaires and in-person interviews on sun exposure in relatively small populations. Two large studies with respect to the impact of naevus burden on melanoma outcome (14, 15), have reported conflicting results, while other susceptibility risk factors, including skin lesions representative of chronic sun exposure, lentigines and actinic keratosis, and phototype were poorly studied, if analyzed at all. Therefore, we set out to perform a comprehensive exploratory analysis of a large panel of known clinical risk factors for melanoma susceptibility in a large and well-phenotyped contemporary Belgian melanoma population and examined their effect on the melanoma outcome. METHODS Data collection The study was designed and approved by the local ethics com- mittee of the University of Leuven in 2004. Patients with a histologically proven diagnosis of cutaneous melanoma who attended the outpatient clinic of the Dermatology Department at University Hospitals Leuven, Belgium, were phenotyped at the time of inclusion and prospectively followed for relapse till 2014. Patients with in situ, mucosal melanomas and unknown primary melanoma were excluded. Trained dermatology residents performed a full skin examina- tion for melanoma susceptibility risk factors. Sun damage signs This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta Journal Compilation © 2019 Acta Dermato-Venereologica.