Trends in clinical characteristics, outcomes, and prognostic factors in melanoma: A retrospective real-world analysis.

Abstract

e21586 Background: Melanoma remains a challenging heterogeneous malignancy with outcomes influenced by its stage at presentation and tumor biology. Understanding the institutional patterns at presentation, treatment utilization, and survival outcomes are essential, especially when real-world outcomes from our region remain underreported. This study aims to characterize the demographic features, explore the survival outcomes, and evaluate the factors associated with patient’s survival treated at a large academic medical center. Methods: We retrospectively analyzed adult (>18 years old) melanoma patients treated at AUBMC (1/2012–12/2024). Demographic data, tumor characteristics, treatment modalities, and clinical outcomes were extracted and analyzed from electronic health records. Overall survival (OS) and progression-free survival (PFS) were estimated using Kaplan-Meier methods, and associations between covariates and survival outcomes were evaluated via Cox proportional hazards regression. Multivariable Cox proportional hazards (CPH) models were used to adjust for confounding. Finally, OS was estimated using KM and compared across systemic treatment groups using the log-rank test. Multivariable Cox proportional hazards models were used to adjust for baseline prognostic factors. Results: Among 314 patients, median age at diagnosis was 56 years (IQR, 46–68), 51.6% were male, and median Charlson Comorbidity Index was 4. The most common histology was superficial-spreading melanoma (25.5%). At presentation, 31.1% had a Breslow thickness >2mm, and the median melanoma diameter was 15 mm. At diagnosis, 12.4% of patients had stage III disease, and 10.5% had stage IV disease. Overall, 80.3% were metastasis-free at diagnosis, while 2.9% had brain metastasis. At a median follow up of 27 months, 1-year and 2-year OS were 93% (95% CI 89%–96%) and 87% (95% CI, 81%–91%), respectively. In a multivariable CPH model, higher Breslow thickness was independently associated with worse OS (HR 3.83, 95% CI 1.06–13.87, p = 0.041). Kaplan–Meier analysis suggested improved OS with immunotherapy-containing regimens (p < 0.01); however, this association was not significant after multivariable adjustment (p = 0.2), suggesting that baseline disease characteristics likely explained the unadjusted differences. Conclusions: In this real world cohort, breslow thickness emerged as an independent predictor of worse overall survival. Survival outcomes were also favorable, with high 1- and 2-year OS rates. These findings support the value of real-world data in understanding treatment outcomes, and explore the need to develop risk-adapted personalized models to guide future therapeutic strategies.