High-Risk Melanomas Often on Head or Neck, Study Finds
WEDNESDAY, Aug. 20, 2014 -- The speed at which cancer cells grow may help doctors diagnose and treat the most aggressive melanomas, researchers say.
Using this measure, investigators have found that the deadliest skin cancers occur most often on the head and neck of older men with a long history of sun exposure.
These lesions also grow quickly and are often colorless, the researchers discovered.
Rapid cell growth -- called "high mitotic rate" -- is associated with poorer prognosis in patients with melanoma. For this new study, the Australian research team examined the physical characteristics of melanomas and their rate of cell division to help doctors know how to spot these faster-growing cancers.
Currently, the seriousness of a melanoma is established by its depth. "Now we might add the mitotic rate as part of that prognostic factor," said Dr. Doris Day, a dermatologist at Lenox Hill Hospital in New York City, who had no part in the study.
"You would expect that cells that are dividing faster make for more aggressive melanomas that are going to have a worse prognosis," said Day.
That most of these aggressive cancers were found on exposed areas of men with significant sun histories indicates that prolonged exposure to sunlight increases the odds of having more aggressive melanomas, Day noted.
"It makes me worry about all these young women who go to tanning salons, because of their chronic exposure," Day said. "I'm worried that 20 or 30 years from now we are going to see these women developing this worse type of melanoma."
In the United States, about 9,000 people die of melanomas of the skin each year, according to the U.S. Centers for Disease Control and Prevention.
Day said the key to treating melanoma is diagnosing it early.
Perhaps melanomas with high mitotic rates will be treated differently than those with lower rates, she added.
"We may now get more aggressive in the treatment of melanoma that is not deep but has a high mitotic rate. Instead of just cutting it out, we may add in chemotherapy," she said. "So we may change how we evaluate melanomas and how we treat them."
But before mitotic rate can be used as a predictor of the aggressiveness of melanomas, the results from this study will have to be duplicated, Day said.
Another expert, Dr. Homere Al Moutran, of Staten Island University Hospital in New York City, agreed. "Mitotic rate, even though not universally evaluated for melanoma, has been shown to be a significant prognostic indicator in skin cancer," he said.
The American Academy of Dermatology says inclusion of mitotic rate in skin cancer reports is an option, he noted. "This study shows a possible particular behavior for mitotically active melanoma, but more studies are needed to define whether mitotic rates should become a standard independent factor in these tumors," Al Moutran said.
For the study published online Aug. 20 in JAMA Dermatology, a research team led by Dr. Sarah Shen, from Alfred Hospital in Victoria, looked at the mitotic rates of melanomas in more than 1,400 patients.
The investigators found that melanomas with higher mitotic rates were more likely to occur on the head and neck, grow faster and appear without color.
These cancers were more likely to occur in men 70 and older and in people with a history of sun damage, called solar keratosis -- rough, raised areas on skin that's been exposed to the sun for long periods.
A history of blistering sunburns and a family history of melanoma, however, were associated with cancers having lower mitotic rates, the researchers said.
New treatments are improving survival of people with advanced melanoma, Day said. "There are now some genetic-based treatments and some immune-based treatments," she said.
"This has taken what was a death sentence and made it into a chronic illness. People are now living four and five years when they would have died in six months," Day explained.
What's sad, she added, is that skin cancer is largely preventable. "A lot of cancers you can't do anything about, but skin cancers are up to 80 percent preventable by just adjusting behavior," she said.
For more about melanoma, visit the American Cancer Society.
Posted: August 2014
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