Melanomas (skin cancers) are more likely to grow rapidly 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, rapidly progressing melanoma is more likely to occur in elderly men and individuals with fewer moles and freckles, and its cells tend to divide more quickly and have fewer pigments than those of slower-growing cancers.
"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 cancer?the 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. 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.
"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.
(Arch Dermatol. 2006;142:1551-1558. Available pre-embargo to the media at www.jamamedia.org.)
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. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
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."
