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The Impact of Obesity on Surgically Treated Locoregional Melanoma

  • Melanoma
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Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The impact of obesity on early-stage melanoma is poorly understood. We examined the impact of overweight and obesity on clinical outcomes in locoregional melanoma.

Methods

Adults who underwent surgery at Emory University Healthcare between 2010 and 2017 for clinically stage I–II cutaneous melanoma, with known stage, height, and weight at the time of presentation, were identified. The relationship between body mass index (BMI) and clinicopathologic characteristics was assessed.

Results

Of 1756 patients, 584 were obese (33.2%; BMI ≥ 30), 658 were overweight (37.5%; BMI ≥ 25 and < 30), and 514 were normal weight (29.3%; BMI < 25). Demographics associated with obesity included male sex (odds ratio [OR] 2.6, 95% confidence interval [CI] 2.1–3.3; p < 0.001) and lower income (OR 1.5, 95% CI 1.2–1.9; p = 0.003). Melanomas in obese patients were thicker (2.0 ± 0.2 mm) than in overweight (1.7 ± 0.1 mm) or normal-weight patients (1.4 ± 0.1 mm; p = 0.002). Ulceration, mitoses, BRAF status, and sentinel lymph node (SLN) status were not affected by obesity. In multivariable analysis, obesity independently predicted increased odds of pathologic stage II melanoma (vs. stage 0 or I; OR 1.9, 95% CI 1.4–2.7, p = 0.001), but not pathologic stage III melanoma (p > 0.05). At 33 months’ median follow-up, obesity was not an independent predictor of stage-specific overall survival (p > 0.05).

Conclusion

Obese patients are nearly twice as likely as their normal-weight peers to present with thicker melanomas, but they have similar stage-specific overall survival and SLN positivity. Obesity may promote more aggressive growth of the primary tumor, and barriers to preventive care in obese patients may exacerbate later-stage presentation.

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Acknowledgment

The authors would like to acknowledge the support of the Melanoma Research Foundation (award number 0000044263). Additional funding was provided by an Emory Winship Pilot Grant. Research reported in this publication was supported in part by the Cancer Tissue and Pathology and the Biostatistics Shared Resources of Winship Cancer Institute of Emory University.

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Author notes

  1. Constance S. Harrell Shreckengost and Marvi Tariq shared co-first authorship and contributed equally to this study.

Authors and Affiliations

  1. Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA

    Constance S. Harrell Shreckengost MD, PhD, Marvi Tariq MD, Clara R. Farley MD, Keith A. Delman MD, FACS & Michael C. Lowe MD

  2. Biostatistics and Bioinformatics Shared Resource, Winship Cancer Institute, Atlanta, GA, USA

    Chao Zhang PhD

  3. Department of Hematology/Oncology, Emory University School of Medicine, Atlanta, GA, USA

    Ragini R. Kudchadkar MD

  4. Division of Surgical Oncology, Winship Cancer Institute, Atlanta, GA, USA

    Michael C. Lowe MD

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  1. Constance S. Harrell Shreckengost MD, PhD
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  3. Clara R. Farley MD
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Contributions

CSHS, MT, and MCL conceived the study and wrote the manuscript, and CZ and CSHS performed the data analysis. All authors reviewed and edited the manuscript.

Corresponding author

Correspondence to Michael C. Lowe MD.

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Disclosure

Ragini Kudchadkar is a member of the Advisory Boards of Merck, BMS, Norvartis, and Regeneron. Constance S. Harrell Shreckengost, Marvi Tariq, Clara R. Farley, Chao Zhang, Keith A. Delman, and Michael C. Lowe have no conflicts of interest to declare.

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Harrell Shreckengost, C.S., Tariq, M., Farley, C.R. et al. The Impact of Obesity on Surgically Treated Locoregional Melanoma. Ann Surg Oncol 28, 6140–6151 (2021). https://doi.org/10.1245/s10434-021-09773-7

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