Veterans Affairs patients were more likely to be diagnosed with ulcerated, very thick (≥4.00 mm), and more advanced melanomas.
Clinical Pearls
This study performed a comparative analysis of 15,334 Veterans Affairs patients to 166,265 patients within the general population diagnosed with initial invasive melanoma between January 2009 to December 2017.
Veterans Affairs patients were more likely to be diagnosed with ulcerated, very thick (≥4.00 mm), and more advanced melanomas. Age-adjusted melanoma-specific survival rates were lower in veterans in all but one age range (>80 years old).
Overall, this study found an increased relative proportion of advanced disease and poorer melanoma-specific survival outcomes among veterans compared to the general population.
Discussion:
The incidence and mortality of melanoma in veterans has not been well characterized in the literature. This may be due to historic underrepresentation of data from the Veterans Health Administration in national datasets. Veterans are also most often in the highest-risk demographic groups for developing melanoma, with the majority of veterans being white (80%) and men (92%). This study aimed to understand how melanoma impacts this high-risk population.
In this study, the authors used data from the Veterans Affairs Cancer Registry (VACR) and National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) registry to determine patient and tumor characteristics as well as melanoma-specific survival outcomes for veterans and members of the general population of the United States respectively. Those included in the study must have been diagnosed with initial invasive melanoma between January 2009 and December 2017. Tumor specific information collected included melanoma subtype, thickness, ulceration, and anatomic location.
The analysis included 15,334 veterans and 166,265 members of the general population diagnosed with initial invasive melanoma. Standardized mean differences were calculated and Kaplan Meier curves in addition to 5-year melanoma-specific survival rates were used to compare survival between both groups. The authors found ulceration of tumors was more likely to be present in veterans (20.9%) than the general population (12.4%). Tumors greater than or equal to 4.00 mm were also found more often in veterans (10.4%) as opposed to the SEER population (6.4%). Those within the general population were also more likely to present with localized disease (82.1% vs 80.3% in veterans) and the superficial spreading subtype of melanoma (32.3% vs 25.2% in veterans). Finally, the five-year melanoma-specific survival rate was lower in veterans (87.4%) than the SEER population (91.6%). Additionally, greater than two thirds of melanomas in both populations were located on either the trunk, head and neck area, or upper extremities. Overall, veterans were more likely to present with more severe disease and experienced worse melanoma-specific survival outcomes than members of the general population.
Limitations of this study included the fact that the SEER registry may include veterans as well, leading to possible double-counting of subjects. Additionally, there was equal geographic distribution of subjects in the VACR registry, however, the SEER registry disproportionately involved patients in the Pacific region. Further studies are necessary to better understand the impact of melanoma on the veteran population.
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