How Does Lesion Visibility Affect Melanoma Prognosis?

Patients with nonvisible lesions more likely to have T3 or T4 tumors, positive lymph nodes, higher-risk stage

By Dermsquared Editorial Team | October 11, 2023

WEDNESDAY, Oct. 11, 2023  -- Nonvisibility of suspicious lesions by patients is associated with higher T-stage tumors, higher-risk stage lesions, and positive lymph nodes, according to a research letter published online Oct. 3 in the Journal of the American Academy of Dermatology.

Emily Everdell, from Albany Medical College in New York, and colleagues conducted a retrospective analysis of patients diagnosed with invasive melanoma and treated surgically between Aug. 1, 2018, and Nov. 1, 2021, to examine whether the visibility of suspicious lesions by patients leads to earlier diagnosis of melanoma. Data were included for 382 patients: 53 and 47 percent had visible and nonvisible lesions, respectively.

The researchers found that men were more likely to present at diagnosis with a nonvisible lesion than women (odds ratio, 1.55). Overall, 53, 23, 14, and 10 percent of patients were diagnosed with T1, T2, T3, and T4 lesions, respectively. Compared with those with visible lesions, patients with nonvisible lesions were significantly more likely to have T3 or T4 versus T1 or T2 tumors (odds ratio, 2.22). For patients with T4 lesions, 63 percent of the lesions were nonvisible. Sixteen percent of patients had positive nodes; 60 percent of these patients had nonvisible lesions (odds ratio, 1.87). Sixty-seven percent of patients diagnosed with high-risk stage lesions had lesions in nonvisible locations (odds ratio, 2.65). Features of regression were more likely in nonvisible lesions (odds ratio, 2.4).

"These findings may identify patient nonvisibility as a risk factor for advanced melanoma," the authors write. "Our findings emphasize the importance of continued vigilance by dermatologists to perform full-body skin examinations, paying particularly close attention to nonvisible areas."


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