Contrasting Survival Outcomes and Patient Characteristics in 5,815 Patients with Stage II and III Melanoma : A Nationwide Population-Based Registry Study from Sweden
Marjanovic, Michelle ; Mikiver, Rasmus ; Nielsen, Kari LU
; Isaksson, Karolin
LU
and Claeson, Magdelena
(2025)
In The British journal of dermatology
- Abstract
BACKGROUND: Prognostic stratification is essential for guiding treatment and follow-up in cutaneous melanoma. Previous international studies suggest that patients with localized stage IIB and IIC melanoma have poorer survival rates than those with lymph node involvement in stage IIIA. Nevertheless, Swedish guidelines still recommend less frequent follow-up for stage II than for stage III melanoma patients.
OBJECTIVES: To evaluate melanoma-specific survival and characteristics of Swedish patients with stage II-III melanoma.
METHODS: This study included all Swedish adults diagnosed with stage II-III melanoma (pathologically confirmed) between January 1, 2001 and December 31, 2018. Data were obtained through linkage between the... (More)
BACKGROUND: Prognostic stratification is essential for guiding treatment and follow-up in cutaneous melanoma. Previous international studies suggest that patients with localized stage IIB and IIC melanoma have poorer survival rates than those with lymph node involvement in stage IIIA. Nevertheless, Swedish guidelines still recommend less frequent follow-up for stage II than for stage III melanoma patients.
OBJECTIVES: To evaluate melanoma-specific survival and characteristics of Swedish patients with stage II-III melanoma.
METHODS: This study included all Swedish adults diagnosed with stage II-III melanoma (pathologically confirmed) between January 1, 2001 and December 31, 2018. Data were obtained through linkage between the Swedish Melanoma Register, the National Cause of Death Register, and several other nationwide population-based registers. Clinicopathological characteristics, comorbidities, socioeconomic factors, as well as 10-year melanoma-specific survival rates and their corresponding 95% confidence intervals (CIs) were analysed across substages. Cox regression models assessed the association between melanoma-specific survival and melanoma substages with hazard ratios (HRs) and 95% CIs calculated for both crude and adjusted models.
RESULTS: The 10-year melanoma-specific survival rates among 5,815 patients with stage II-III melanoma were: IIA: 86%, IIB: 73%, IIC: 61%, IIIA: 78%, IIIB: 56%, IIIC: 43%, and IIID: 19%. Stage IIC patients (median age: 70.0 years, 59.2% men) were older, more likely male, had more comorbidities (e.g., hypertension, type 2 diabetes), and lower socioeconomic status compared to stage IIIA patients (median age: 55.0 years, 51.5% male). Regression analyses revealed that differences in age, sex, and thickness contributed to contrasting survival differences between stage IIC and IIIA, but a significant survival difference remained after adjusting for these factors.
CONCLUSIONS: Patients in Sweden with localized stage IIC melanoma have significantly worse melanoma-specific survival than those with lymph node involvement in stage IIIA, with stage-specific differences in age, sex, comorbidities, and socioeconomic status. These findings underscore the need for better treatment for thick, localized melanoma, and suggest reconsideration of current Swedish guidelines, while stage IIC patients receive less intensive follow-up than those with stage IIIA.
(Less)
- author
- Marjanovic, Michelle
; Mikiver, Rasmus
; Nielsen, Kari
LU
; Isaksson, Karolin
LU
and Claeson, Magdelena
- organization
- publishing date
- 2025-11-26
- type
- Contribution to journal
- publication status
- epub
- subject
- in
- The British journal of dermatology
- article number
- ljaf478
- publisher
- Wiley-Blackwell
- external identifiers
-
- pmid:41296675
- ISSN
- 1365-2133
- DOI
- 10.1093/bjd/ljaf478
- language
- English
- LU publication?
- yes
- additional info
- © The Author(s) 2025. Published by Oxford University Press on behalf of British Association of Dermatologists.
- id
- 4a0c636a-1a6e-43a4-aade-4cf1571c60b7
- date added to LUP
- 2025-11-28 11:20:45
- date last changed
- 2025-11-28 13:22:50
@article{4a0c636a-1a6e-43a4-aade-4cf1571c60b7,
abstract = {{<p>BACKGROUND: Prognostic stratification is essential for guiding treatment and follow-up in cutaneous melanoma. Previous international studies suggest that patients with localized stage IIB and IIC melanoma have poorer survival rates than those with lymph node involvement in stage IIIA. Nevertheless, Swedish guidelines still recommend less frequent follow-up for stage II than for stage III melanoma patients.</p><p>OBJECTIVES: To evaluate melanoma-specific survival and characteristics of Swedish patients with stage II-III melanoma.</p><p>METHODS: This study included all Swedish adults diagnosed with stage II-III melanoma (pathologically confirmed) between January 1, 2001 and December 31, 2018. Data were obtained through linkage between the Swedish Melanoma Register, the National Cause of Death Register, and several other nationwide population-based registers. Clinicopathological characteristics, comorbidities, socioeconomic factors, as well as 10-year melanoma-specific survival rates and their corresponding 95% confidence intervals (CIs) were analysed across substages. Cox regression models assessed the association between melanoma-specific survival and melanoma substages with hazard ratios (HRs) and 95% CIs calculated for both crude and adjusted models.</p><p>RESULTS: The 10-year melanoma-specific survival rates among 5,815 patients with stage II-III melanoma were: IIA: 86%, IIB: 73%, IIC: 61%, IIIA: 78%, IIIB: 56%, IIIC: 43%, and IIID: 19%. Stage IIC patients (median age: 70.0 years, 59.2% men) were older, more likely male, had more comorbidities (e.g., hypertension, type 2 diabetes), and lower socioeconomic status compared to stage IIIA patients (median age: 55.0 years, 51.5% male). Regression analyses revealed that differences in age, sex, and thickness contributed to contrasting survival differences between stage IIC and IIIA, but a significant survival difference remained after adjusting for these factors.</p><p>CONCLUSIONS: Patients in Sweden with localized stage IIC melanoma have significantly worse melanoma-specific survival than those with lymph node involvement in stage IIIA, with stage-specific differences in age, sex, comorbidities, and socioeconomic status. These findings underscore the need for better treatment for thick, localized melanoma, and suggest reconsideration of current Swedish guidelines, while stage IIC patients receive less intensive follow-up than those with stage IIIA.</p>}},
author = {{Marjanovic, Michelle and Mikiver, Rasmus and Nielsen, Kari and Isaksson, Karolin and Claeson, Magdelena}},
issn = {{1365-2133}},
language = {{eng}},
month = {{11}},
publisher = {{Wiley-Blackwell}},
series = {{The British journal of dermatology}},
title = {{Contrasting Survival Outcomes and Patient Characteristics in 5,815 Patients with Stage II and III Melanoma : A Nationwide Population-Based Registry Study from Sweden}},
url = {{http://dx.doi.org/10.1093/bjd/ljaf478}},
doi = {{10.1093/bjd/ljaf478}},
year = {{2025}},
}