SAN DIEGO — Over the next 15 years, 5-year survivors of melanoma have a 91.5% chance of having achieved cure, Duane C. Whitaker, M.D., reported at a melanoma update sponsored by the Scripps Clinic.
“Stated another way, all comers with an invasive melanoma—regardless of stage—who reach 5-year survival have a 91%-92% odds of surviving another 15 years,” said Dr. Whitaker, professor of surgical dermatology at the University of Iowa, Iowa City. “So we can say that in 2005, 5-year survival is nearly equivalent to cure.”
The figures come from an analysis of data from the Surveillance, Epidemiology, and End Results (SEER) program of the National Cancer Institute. His study revealed that 5-year survival rates of all invasive melanoma cases between 1975 and 1996 increased about 10%, from 82.1% to 91.9%.
“We believe there is earlier recognition and treatment of most cancers [today] because of better patient education, good physician monitoring, and so forth,” he said.
The finding is important because most melanoma patients want to know their odds of surviving. “To have the word melanoma used in relation to you is a major event in your life,” he noted. “From a patient standpoint, at least until they're able to put it in some perspective and talk with all their family and friends, even in situ melanoma has a big impact. It's our role to help patients adjust and fit [this diagnosis] into the scheme of their life.”
Dr. Whitaker uses a compressed form of the American Joint Committee on Cancer's melanoma staging classification to stage disease in his patients. In this system, stage I comprises all invasive melanomas up to 2.0 mm. Stage II comprises all melanomas of any thickness greater than 2.0 mm (in the absence of known metastases). Stage III comprises all single site, regional nodal disease, and stage IV comprises all visceral or distant nodal, skin, and soft tissue disease.
According to the latest SEER data, 5-year melanoma survival rates stand as follows: 88%-100% for stage I disease; 79% for depths up to 4.0 mm in patients with stage II disease and 67% for those of all greater depths; 27%-69% for patients with stage III disease; and 20% or less for those with stage IV disease.
In 2004, there were 55,000 new cases of invasive melanoma in the United States and 41,000 cases of in situ melanoma. “Therefore, there are about 100,000 cases which require a procedure every year,” Dr. Whitaker said. “There's a lot of work out there to be done.”
Invasive melanoma accounts for 4% of all newly diagnosed cancers in the United States per year and 1.4% of cancer-related deaths per year.
When patients ask Dr. Whitaker what caused their melanoma, he lists the culprits attributed to all forms of cancer: the environment, senescence, trauma, and genetics. “I say to patients, 'One thing you can affect is protection from sun exposure.'”
He added that when celebrities with melanoma are profiled in the media, “those voices are heard by the public. I am amazed by patients who tell me what they know about changing moles that are dark in color, and so forth.”