Stage III, IV melanoma survival rates languish

Orlando - Nearly 60,000 people in the United States will be diagnosed with melanoma this year, while 7,770 will die of the disease (Jemal A, Murray T, Ward E, et al: Cancer statistics, 2005. CA Cancer J Clin 55:10-30, 2005).

The results of a new study released from the John Wayne Cancer Institute (JWCI) in Santa Monica, Calif., indicate that the overall survival rate has not improved in patients suffering from advanced melanoma. Survival in stage III averages 35 to 50 percent, while stage IV melanoma patients experience a 5 to 10 percent survival average.

Speaking at the American Society of Clinical Oncology meeting here, Dr. Young said the study looked at 1,422 patients who were treated at JWCI within four months of their diagnosis. Any patients who had received experimental adjuvants were excluded from the study.

Survival rates

Researchers looked at the survival rates of 882 patients from this cohort, who had been divided across three treatment eras and matched into 294 sets: 1971-81, 1982-92, and 1993-2003.

"There were no significant survival differences in 232 matched sets with palpable nodes, or in 62 matched sets with nonpalpable nodes.

"Among patients with nonpalpable nodes, there was a trend toward better five-year survival for patients in the most recent era compared to the earlier two eras (68 percent vs. 54 percent.)"

The apparent improvement for patients with nonpalpable nodes in the most recent era is most likely a result of better staging rather than improved treatments, according to Dr. Young.

He says, "In stage III melanoma patients, we are now detecting a very small amount of tumor burden, which would have been diagnosed as stage II disease 20 or 30 years ago, as methods of detection were not nearly as sensitive.

"Even when lymph node dissections had been done, the nodes would only have been routinely halved once to see if there was tumor. Currently, with the sentinel node biopsy technique, instead of cutting the node in half, we divide each node into about (seven to 10) pieces so that tumor burden is recognized when it is very small - even less than 2 mm. As a result, more cancers are being categorized as stage III than in the past."

Dr. Young says that is simply an indication that early detection is still the key to successful treatment of melanoma.

"Improved staging methods combined with improved survival when melanoma is detected early indicates people are doing better now as a result of early detection," he says. "The best thing patients and physicians can do is to be on top of it - just pay attention - because we can clearly show that if disease is detected early, even after it has spread to the lymph nodes, but without any evidence of tumor there, then these patients are doing better in long-term survival as well. This is a disease where early detection is particularly relevant."

What it all means

Darrell S. Rigel, M.D., clinical professor at New York University and past president of the American Academy of Dermatology, who specializes in skin cancer, agrees.

He explains what the study will mean to dermatologists.

"What's interesting is that in the past 50 years, the overall survival rates in melanoma have increased dramatically. We are seeing people earlier and earlier than in the past, so the survival rate has improved because we detect and treat melanoma earlier. What the results of this study boil down to is that the critical nature of early detection is even more important than we understood in the past - because we, as dermatologists, are on the front lines in terms of early detection."