61: Smoking imparts shorter disease specific survival in patients with primary cutaneous melanoma

Friday, March 24, 2023

11:04 AM – 11:14 AM

Location: Veterans Memorial Auditorium

Abstract Presenter(s)

Katherine Jackson, MD

Surgical Oncology Fellow
St. John's Cancer Institute
Santa Monica, California, United States

Disclosure(s): No financial relationships to disclose

First Author(s)

Katherine Jackson, MD

Surgical Oncology Fellow
St. John's Cancer Institute
Santa Monica, California, United States

Disclosure(s): No financial relationships to disclose

Author(s)

PJ

Peter Jones, MD

Former Faculty
St John's Cancer Institute, United States

Disclosure information not submitted.
Laura Fluke, DO, FACS

Surgical Oncology Fellow
Providence Saint John's Cancer Institute
Santa Monica, California, United States

Disclosure(s): No financial relationships to disclose
TF

Trevan Fischer, MD

Assistant Program Director
Saint John's Cancer Institute, Donald L Morton CGSO Fellowship, United States

Disclosure information not submitted.
SS

Stacey Stern, MS

Data Manager
Saint John's Cancer Institute, United States

Disclosure information not submitted.
John Thompson, MD

Emeritus Professor Melanoma and Surgical Oncology
Melanoma Institute Australia, The University of Sydney
North Sydney, New South Wales, Australia

Disclosure information not submitted.
AC

Alistair Cochran, MD

University of California Los Angeles
Los Angeles, California, United States

Disclosure information not submitted.
Mark B. Faries, MD (he/him/his)

Professor of Surgery
The Angeles Clinic and Research Institute/ Cedars-Sinai Medical Center
Los Angeles, California, United States

Disclosure information not submitted.
DH

Dave Hoon, PhD

Professor, Director of Dept. of Translational Molecular Medicine
St John's Cancer Institute, United States

Disclosure information not submitted.
LF

Leland Foshag, MD

Fellowship Program Director
St John's Cancer Institute, United States

Disclosure information not submitted.

Disclosure(s):

Katherine Jackson, MD: No financial relationships to disclose

Laura Fluke, DO, FACS: No financial relationships to disclose

Introduction: Multiple studies have confirmed that tobacco smoking does not increase the risk of developing melanoma and may actually reduce it. However, the impact of smoking on progression and prognosis of established melanoma is not well defined.

Methods: We performed a large case-control study using data from the multinational Multicenter Selective Lymphadenectomy Trials (MSLT) I & II. Patients with smoking status recorded were included. Melanoma-specific survival (MSS) of current, former and never smokers was assessed. For cigarette smokers, cigarettes per day and years smoked were recorded. Patient subgroups based on sentinel lymph node (SLN) management and positivity were examined.

Results: MSLT I accrued from January 1994 to March 2002, and MSLT II from December 2004 to March 2014. Smoking status was available for 6169 patients who are analyzed here. There were 3444 (58%) never-smokers, 1674 (27%) former smokers, and 1051 (17%) active smokers. Active smokers were younger (p < 0.001) and more likely to have thicker (p=0.001) and/or ulcerated tumors (p < 0.001). On multivariable analysis, MSS was associated with age (HR 1.01, p< 0.001), sex (HR 1.30, p=0.01), Breslow (HR 1.10, p< 0.001), ulceration (HR 2.34, p< 0.001), truncal primary (HR 1.37, p< 0.001), SLN metastasis (HR 2.33, p < 0.001), and current smoking (HR 1.47, p< 0.001), but not former smoking (HR 1.01, p=0.89). Patients with a negative SLN biopsy had the strongest correlation between current smoking and decreased MSS [Figure 1]. The significantly shortened MSS for active smokers among the SLN-negative patients was consistent for MSLT-I (p=0.008) and MSLT-II (p < 0.05) when the trials were assessed independently. Smoking ≥ 20 cigarettes/day more than doubled the risk of death for SLN negative patients (HR 2.11, CI 1.38,3.21 p=0.001).

Conclusions: Smoking at the time of melanoma diagnosis is an important independent prognostic factor for patients with early clinical stage cutaneous melanoma. Inclusion of smoking as a stratification factor in clinical trials should be considered, and increased post operative vigilance in patients who smoke is warranted.

Learning Objectives:

describe which patient and disease characteristics are associated with active smoking status
describe what impact smoking has on melanoma specific survival
identify which groups of patients have the biggest impact of smoking on their survival