Discordance of pathological thin melanoma thickness and T stage in SEER registry: impacts on clinical management and research directions

// Zhichao Wang 1, * , Haizhou Li 1, * , Xinyang Liu 2, * , Jinhong Bae 1 , Xin Huang 1 , Yashan Gao 1 , Xiangwen Xu 1 , Jihan Guo 1 , Lin Lu 1 , Tao Zan 1 and Qingfeng Li 1 1 Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China 2 Zhongshan Hospital, Fudan University, Shanghai, China * These authors contributed equally to this work Correspondence to: Tao Zan, email: zantaodoctor@gmail.com Qingfeng Li, email: dr.liqingfeng@shsmu.edu.cn Keywords: melanoma; SEER; tumor thickness; T stage; discordance Received: July 26, 2017      Accepted: October 03, 2017      Published: October 24, 2017 ABSTRACT Background: Ultrathin melanoma was previously demonstrated to have higher risk for melanoma-specific mortality using SEER database. However, these guideline-changing conclusions has been recently challenged by miscoding of thickness. This present study was performed to assess the prognosis of thin and ultrathin melanoma using only surgically-treated, pathologically confirmed and after removal of discordant cases. Methods: Melanoma patients from SEER database who were initially diagnosed with histologically confirmed and surgically treated melanoma from 1998 to 2012 were included. Subjects with discordance between T stage and tumor thickness were excluded. Kaplan-Meier curves, log-rank test and multivariate Cox proportional hazards regression models were used. Results: 55,754 patients met the strict inclusion criteria, but 16 (0.02%) and 803 (1.4%) patients were removed due to T0 stage and discordance between T stage and thickness, respectively. Therefore, 54,935 patients entered the analyses, among which 52,751 were LN negative and 2,184 were LN positive. In either overall or LN-negative patients, a straightforward dose-effect relationship of larger thickness with increasing mortality was observed. In contrast, in LN positive patients, the T1 subgroup demonstrated a similar survival with tumors in T2 mm subgroup. Multivariable analysis revealed same pattern, and significant interaction between T stage and LN involvement was found. Further categorizing T1 melanoma into 10 equal 0.10 mm increments demonstrated an unexpected “N”-shaped pattern of mortality in overall and LN negative ultrathin melanoma but not in LN positive melanoma. Conclusions: No difference in mortality was observed in T1-3 tumors with LN involvement. External and independent validation studies are warranted.