Abstract
The lower limb is a common site for melanoma in women, but the reason for this is not fully understood. To investigate this phenomenon in more detail, we assessed the specific subsites of primary melanoma occurring on the lower limbs of females compared with males across age groups. In a records-based study at an oncology hospital in north-west of England, among an unselected sample of patients with primary invasive melanoma treated between 2002–2015, information was collected on patient age at diagnosis, sex, and co-morbidities, and the tumor thickness and anatomical subsite (thigh, lower leg, foot for lower limb). Of a total sample of 1,522 patients, 316 (227, 72% female) had lower limb melanoma. The most common subsite was lower leg (142 cases with F:M ratio =3.74), followed by thigh (55 cases with F:M = 1.83) and feet (30 cases with F:M = 1.15). At ages <40 years the odds of thigh to foot melanoma was 20 times higher in females than in males (OR 20.0, 95% CI 2.6-152.6) and 7.5 times higher on the lower limb (OR 7.5, 95% CI 1.1–49.2). For ages 40+ years, the odds of females developing thigh melanoma compared to foot melanoma was similar in males versus females (OR 0.8), while the corresponding odds of lower leg melanoma in females versus males remained significantly increased at ages 40–59 and 60+ (OR 4.2 and 2.8 respectively). Our study demonstrates the female predilection for lower limb melanoma persists over most but not all subsites.However, there is heterogeneity in the female to male occurence of lower limb melanoma across subsites and at different ages, which may be linked to relative influence of genetic and environmental risk factors.
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Acknowledgements
We thank Professor Richard Marais who helped to secure project funding. We are also very grateful to the following former medical students who assisted this study by extracting data anonymously from medical records of unselected melanoma patients treated at The Christie NHS Foundation Trust: Ms Imogen Bambrough-Stimson, Miss Bethan Clayton, Dr. Omar El-Omar , Dr. Bilal Fakim, Ms Tonia Forjoe, Dr. Titus-Andrei Grecu, Dr. Nathan Griffiths , Mr Ali Kia, Mr Matthew Maden, Ms Monica Marcean, Miss Roxana Moscalu, Mr Ferhan Muneeb , Miss Anushah Nadeem, Miss Alice Neilson, Dr. Judith Osuji, Mr Mehul Patel, Dr. Haseem Raja, Mr. Amir Parsa Salahi, Dr Musfira Shakeel, Miss Tricia Tay, Dr. Thomas Turner, Ms Tanvi Ujoodha, Miss Laura Webb, Dr Zen Zuan Yong, Mr Sharanniyan Ragavan, Miss Yen Jia Soh, Dr. Aleksandar Vucicevic, and Mr Won Young Yoon.
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Supported by CRUK Grant (Ref. C5759/A20971).
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All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Musfira Shakeel Megan Grant and Zainab Jiyad. The first draft of the manuscript was written by Adele Green and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
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Shakeel, M., Jiyad, Z., Grant, M. et al. Melanoma predilection for the lower limbs of women compared with men. Arch Dermatol Res 315, 633–636 (2023). https://doi.org/10.1007/s00403-022-02375-7
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DOI: https://doi.org/10.1007/s00403-022-02375-7