Potential Link Between Smoking and Survival in Early-Stage Primary Melanoma

By: Bryna Goeking
Posted: Monday, May 6, 2024

It’s no secret that smoking has detrimental effects on one’s health, but how might it affect survival outcomes in patients with melanoma? A recent cohort study, conducted by Katherine M. Jackson, MD, of Saint John’s Cancer Institute at Providence Saint John’s Health Center, Santa Monica, California, and colleagues, discovered an increased risk of death in patients with early-stage primary cutaneous melanoma who smoke. Published in JAMA Network Open, the team’s findings suggest the need to assess smoking status at the time of diagnosis of melanoma, given its potential as a risk factor for disease progression.

“We did not really need another reason to recommend against smoking, but here we have it,” said Mary S. Brady, MD, of Memorial Sloan Kettering Cancer Center, New York, in a companion commentary published in JAMA Network Open.

In this post hoc analyais, the data were derived from randomized, multinational MSLT-I and MSLT-II (Multicenter Selective Lymphadenectomy Trials). A total of 6,279 patients with clinical stage 1 or 2 melanoma (with a Breslow thickness of at least 1 mm or Clark level IV to V) were included in the cohort study, with 1,077 being current smokers. These patients were stratified by smoking frequency (light, moderate, or heavy). Median follow-up for MSLT-I was 110.0 months, and for MSLT-II, it was 67.6 months.

According to the study, smoking 20 or more cigarettes per day doubled the risk of mortality in those with melanoma that had not spread to the lymph nodes (hazard ratio [HR] = 2.06, 95% confidence interval [CI] = 1.36–3.13, P < .001). Between each category, the adjusted risk of melanoma-associated death rose by roughly 20% compared with nonsmokers, with the most significant difference being between light and heavy smokers (HR = 1.45, 95% CI = 1.00–2.09, P = .05). Smokers represented in the cohort study most frequently presented with melanoma on the trunk and least frequently on the head or neck.

Disclosure: For full disclosures of the study authors, visit jamanetwork.com.

JAMA Network Open