The increased survival in malignant cutaneous melanoma (melanoma) is probably due to early diagnosis combined with improved treatment most recently. National health campaigns and screening programs for melanoma detection were started in Sweden several decades ago. We want to assess the influence of tumor characteristics, based on the TNM classification, and of second primary cancers on overall survival in melanoma. We used the Swedish Cancer Registry to assess all-cause survival in melanoma from 2003 to 2015. Hazard ratios (HRs) were estimated using multivariable Cox regression models. A total of 19,773 melanoma patients were diagnosed with TNM data. Survival showed a strong improving trend over time (p-trend <.001). T1a was the most common classification (48.0% of all), while higher T class was associated systematically with worse survival (p-trend <.001). For distant metastases, the HR was 3.17, accounting for 0.9% of the patients. Any types of second primary cancers, other than melanoma, were associated with an HR of 2.00, accounted for 6.7% of all cases. Even if melanoma survival in Sweden ranks among the best national rates, the large percentage of patients with advanced tumors (T3b, T4a, and T4b, 17%) and 21% of deaths with T1a call for improved preventive and follow-up strategies.

Cancer Gene Therapy Group Translational Immunology Research Program University of Helsinki Helsinki Finland

Center for Primary Health Care Research Lund University Malmö Sweden

Comprehensive Cancer Center Helsinki University Hospital Helsinki Finland

Department of Family Medicine and Community Health Icahn School of Medicine at Mount Sinai NY USA

Department of Functional Pathology Center for Community based Healthcare Research and Education School of Medicine Shimane University Izumo Japan

Department of Population Health Science and Policy Icahn School of Medicine at Mount Sinai NY USA

Division of Molecular Genetic Epidemiology German Cancer Research Center Heidelberg Germany

Faculty of Medicine and Biomedical Center in Pilsen Charles University Prague Pilsen Czech Republic

Faculty of Medicine University of Heidelberg Heidelberg Germany

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Survival in melanoma in the nordic countries into the era of targeted and immunological therapies