Marriage prompts earlier presentation of melanoma

Married patients present earlier with localized melanoma than their unmarried counterparts. In a retrospective population-based study that used the Surveillance, Epidemiology, and End Results (SEER) database, among 52,063 adult patients identified with cutaneous melanoma, 45.7% of the married patients presented with T1a disease compared with 43.0% of never married patients, 39.0% of divorced patients, and 32.2% of widowed patients (P<0.001).

Led by Cimarron E. Sharon, from the Hospital of the University of Pennsylvania, investigators queried the SEER database for adults with a pathologically confirmed diagnosis of melanoma with marital status recorded and known sentinel lymph node status. Patients had no evidence of regional or distant metastases. Their median age was 64 years, 59% were men, and 69.7% were married.

As published in JAMA Dermatology, patients who were never married (OR, 1.32; 95%CI, 1.26-1.39), divorced (OR, 1.38; 95% CI, 1.30-1.47), or widowed (OR, 1.70; 95% CI, 1.60-1.81) were more likely to present with a later T stage compared with married patients (P< 0.001 for all) in multivariable analysis.

Widowed patients were more likely to present with T4disease (T4a, 5.6%; T4b, 9.4%) compared with married (T4a, 2.6%; T4b, 3.3%), never married (T4a, 2.9%;T4b, 4.8%), and divorced (T4a, 3.1%; T4b, 5.1%) patients (P< 0.001).

Further, never married, divorced, and widowed patients are less likely to undergo sentinel lymph node biopsy for appropriate lesions.

The findings support increased consideration of spousal training for partner skin examination and perhaps more frequent screening for unmarried patients, according to the authors.

“This study has important implications for counseling patients and recommending frequency of follow-up surveillance,” they wrote. “Clinicians may, for instance, recommend that unmarried patients initiate regular skin examinations at an earlier age and continue them more frequently to detect lesions at an earlier stage. For married patients, encouragement of partners to be present at clinic appointments and undergo basic training for performing a skin examination could perhaps further increase early detection of primary lesions.”

References:

Cimarron E. Sharon, BS; Andrew J. Sinnamon, MD; Michael E. Ming, MD, MSCE, et al. “Association of marital status with T stage at presentation and management of early-stage melanoma.” JAMA Dermatology. April 18, 2018. doi:10.1001/jamadermatol.2018.0233