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FRIMEDBIO-Fri prosj.st. med.,helse,biol

Prognostic factors in cutaneous melanoma - towards a more personalized risk stratification

Alternative title: Prognostiske faktorer for melanom

Awarded: NOK 7.7 mill.

Cutaneous melanoma is the most aggressive and lethal form of skin cancer. Incidence is increasing in Norway. We are ranked third worldwide in melanoma incidence, mortality and disability-adjusted life years. We will study whether patient phenotypes and lifestyle factors are important in survival after melanoma diagnosis using data from the unique large Norwegian Women and Cancer cohort. Little is understood whether individuals with high-risk phenotypes or lifestyles are more likely to develop more aggressive melanoma than those without such features. We will also study long-term trends in melanoma tumour thickness and the mortality burden of thin and thick melanomas. Tumour thickness at diagnosis is the cornerstone for staging melanoma with consequences for estimated prognosis, patient management and follow-up. Thin melanoma is more common and have better survival than thicker melanoma, but studies have indicated that not only the death toll of thick but also thin melanoma is severe. Population-based studies with long follow-up are needed and this project takes advantage of the unique Norwegian setting with a national cancer registry.

Norway is ranked third worldwide in cutaneous melanoma (CM) incidence, mortality and disability-adjusted life years. Prognostic factors and risk stratification after CM diagnosis is important. 1) Little is understood whether patients with high risk pigmentary characteristics and many nevi develop more aggressive CM than those without such features. Whether sun exposure has a role in CM survival is controversial. The few available studies have suggested a protective role, the opposite or no association, creating a paradox that the known carcinogen ultraviolet radiation (UVR) can act as a survival enhancer, confusing to physicians and patients. In a unique population-based cohort, we will study pigmentary characteristics, nevi and recent and lifetime UVR exposure as prognostic factors in CM. 2) Tumour thickness is the cornerstone for staging CM with consequences for estimated prognosis, patient management and follow-up. Up-to-date and accurate prognosis is essential to the patient. Identifying optimal thickness cut-points for risk stratification is crucial in the clinic. Thin CM (<1 mm) is more common and have better survival than thicker, but recent studies indicate that not only the death toll of thick but also thin CM is severe, and varies within the <1 mm category. Long follow-up is needed to study thin CMs. The high quality Cancer Registry of Norway (CRN) lacks thickness data prior to 2008. In two pilots we found that thickness is available in the CRN paper archive for 1980-2007 and retrieval is feasible, enabling establishment of a resource of 45,000 CM patients diagnosed in 1980-2018. We will take advantage of this unique Norwegian setting, establish this resource and study, overall and in important subgroups, long-term trends in tumour thickness, the mortality burden of thin and thick CMs, the success of previous (and future) prevention campaigns, and investigate tumour thickness cut-points for risk stratification to guide clinical management and follow-up.

Funding scheme:

FRIMEDBIO-Fri prosj.st. med.,helse,biol

Funding Sources