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Senior Citizen Health & Medicine
Fastest Growing Skin Cancers More Likely to Occur in
Men 70 or Older
Non-factors: age spots, history of sun
exposure,
skin type, history of melanoma
 December
18, 2006 - Faster-growing melanomas (skin cancers) are more
likely to occur in men 70 years or older, and those with fewer moles and
freckles, reports a new study. These rapidly progressing skin cancers
are more likely to grow quickly if they are thicker, symmetrical,
elevated, have regular borders or have symptoms, according to a report
in the December issue of Archives of Dermatology, one of the
JAMA/Archives journals.
In addition, in rapidly progressing melanoma its
cells tend to divide more quickly and have fewer pigments than those of
slower-growing cancers.
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Interestingly, factors that were not associated
with the rate of growth were the number of atypical moles or solar
lentigines (age spots or liver spots), history of sun damage or
blistering sunburns, skin type, eye color, family or personal history of
melanoma, and current or childhood sun exposure.
Anecdotal experience suggests that there is a form
of rapidly growing melanoma, but little is known about its frequency,
rate of growth, or associations, the authors write as background
information in the article.
One previous study suggested that how quickly a
melanoma grew predicted how likely the patient was to relapse at one
year or to survive without relapsing. Other research indicates that
different types of melanoma grow at different rates; for instance, an
aggressive type known as nodular melanoma grows more quickly than any
other kind.
Wendy Liu, M.B.Ch.B., Ph.D., Peter MacCallum Cancer
Center, East Melbourne, Australia, and colleagues investigated melanoma
growth rate in 404 consecutive patients (222 male, 182 female, average
age 54.2) with invasive melanoma.
Participants skin was examined by a dermatologist
and information about such characteristics as the number of typical and
atypical moles was recorded. In addition, the patients were interviewed
as soon as possible after diagnosis and preferably with a friend or
family present.
The researchers gathered information about
demographics, skin cancer risk factors, the characteristics of the tumor
and who first detected the cancerthe patient, a family member or
friend, or a physician.
In addition, all patients and their families were
asked to recall the date at which they first noticed a spot on their
skin from which the melanoma later developed and then the date at which
they noticed the marking had changed or become suspicious.
The researchers used these two dates, the date that
the melanoma was removed as obtained from medical records, and the
thickness of the tumor at the time of removal to estimate the
approximate rate of growth. This method was doubled-checked by comparing
the rate of growth with the tumor mitotic rate, or the rate at which the
cancer cells multiply.
Those tumors with a faster mitotic rate also had a
faster rate of growth as determined by the researchers formula.
Approximately one-third of all the melanomas (141)
grew less than .1 millimeters per month, another one-third (136) grew
between .1 millimeters and .49 millimeters per month, and one-third grew
by .5 millimeters or more per month.
A high rate of growth was associated with tumor
thickness, ulceration (formation of a break or sore on the skin),
amelanosis (lack of pigment in the tumor), regular borders, elevation
and symptoms.
Faster-growing melanomas were more likely to occur
in individuals 70 years or older, in men and in those with fewer moles
and freckles.
In summary, this study provides descriptive data
on the spectrum of melanoma rates of growth and insights into subgroups
of patients with melanoma that are associated with rapid growth, the
authors conclude. We propose that this information on melanoma rate of
growth be incorporated into education programs for patients and health
professionals. Awareness of the clinical features of faster-growing
melanomas could help ensure that aggressive cancers are diagnosed and
treated quickly.
Editor's Note: This study was supported by the
Melbourne Research Scholarship from The University of Melbourne and by
the Fred Bauer research grant from the Australasian College of
Dermatologists.
EDITORIAL: Educate the public about fast-growing
melanomas
The study by Dr. Liu and colleagues provides
physicians with important information about detecting fast-growing
melanomas, writes Dan Lipsker, M.D., Ph.D., of Clinique Dermatologique,
France, in an accompanying editorial.
Public education efforts surrounding slow-growing
melanomas helped improve detection and treatment; in the 1960s, 60
percent of patients diagnosed with melanoma died of the disease, whereas
only 11 percent die today.
Thus, the dermatologic community managed to
recognize the slow-growing form of melanoma, identify its clinical
features, generate public awareness of those clinical features using the
ABCD rule and identify its risk factors to allow primary prevention,
Dr. Lipsker concludes.
The challenge in the coming years will be to do
the same work for fast-growing tumors, and the work by Dr. Liu et al is
a first step in that direction.
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