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Yan Pan - One of the best experts on this subject based on the ideXlab platform.
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differences between pure desmoplastic Melanoma and Superficial Spreading Melanoma in terms of survival distribution and other clinicopathologic features
Journal of The European Academy of Dermatology and Venereology, 2019Co-Authors: John W. Kelly, Catriona Mclean, Matthew Howard, Edmund Wee, Rory Wolfe, Yan PanAbstract:BACKGROUND Pure desmoplastic Melanoma (pDM) is an uncommon subtype of malignant Melanoma with comparative high rates of local recurrence and low rates of sentinel lymph node positivity. The Melanoma-specific survival (MSS) of pDM compared to other Melanoma subtypes is unclear, with conflicting reports and lack of multivariable analyses. OBJECTIVES We aimed to describe clinicopathological characteristics of a cohort of patients with pDM and to compare the MSS of pDM with Superficial Spreading Melanoma (SSM). METHODS A prospective cohort study was performed of all primary invasive cutaneous pDM with known tumour location and thickness reviewed at a tertiary referral centre over 21 years. RESULTS A total of 119 primary cutaneous invasive pDMs from 3570 total invasive cutaneous Melanomas were included. Compared to 2272 SSMs, and due largely to their greater average thickness, patients with pDM had worse MSS (unadjusted hazard ratio, HR, 2.56, 95% confidence interval, CI, 1.56-4.22). After adjustment for clinicopathologic factors (including thickness, ulceration, mitotic rate, age and sex), there was evidence that patients with pDM had an improved MSS (adjusted HR, 0.49; 95% CI, 0.28-0.87). Median thickness of head and neck pDM was greater than non-head and neck pDM (P < 0.001). There was reduced univariable MSS in head and neck pDM compared to the rest of the body. CONCLUSIONS Decreased univariable MSS of patients with pDM compared to SSM was explained by the increased frequency of adverse clinicopathologic features at diagnosis, in particular the greater Breslow thickness of pDM. After adjustment, patients with pDM had half the chance of Melanoma-specific death compared to SSM. Head and neck pDM were thicker at diagnosis compared to the rest of the body, which may account for its poorer survival compared to the rest of the body.
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Differences between pure desmoplastic Melanoma and Superficial Spreading Melanoma in terms of survival, distribution and other clinicopathologic features.
Journal of the European Academy of Dermatology and Venereology : JEADV, 2019Co-Authors: Matthew Howard, John W. Kelly, Catriona Mclean, Edmund Wee, Rory Wolfe, Yan PanAbstract:BACKGROUND Pure desmoplastic Melanoma (pDM) is an uncommon subtype of malignant Melanoma with comparative high rates of local recurrence and low rates of sentinel lymph node positivity. The Melanoma-specific survival (MSS) of pDM compared to other Melanoma subtypes is unclear, with conflicting reports and lack of multivariable analyses. OBJECTIVES We aimed to describe clinicopathological characteristics of a cohort of patients with pDM and to compare the MSS of pDM with Superficial Spreading Melanoma (SSM). METHODS A prospective cohort study was performed of all primary invasive cutaneous pDM with known tumour location and thickness reviewed at a tertiary referral centre over 21 years. RESULTS A total of 119 primary cutaneous invasive pDMs from 3570 total invasive cutaneous Melanomas were included. Compared to 2272 SSMs, and due largely to their greater average thickness, patients with pDM had worse MSS (unadjusted hazard ratio, HR, 2.56, 95% confidence interval, CI, 1.56-4.22). After adjustment for clinicopathologic factors (including thickness, ulceration, mitotic rate, age and sex), there was evidence that patients with pDM had an improved MSS (adjusted HR, 0.49; 95% CI, 0.28-0.87). Median thickness of head and neck pDM was greater than non-head and neck pDM (P
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Nodular Melanoma is less likely than Superficial Spreading Melanoma to be histologically associated with a naevus
The Medical journal of Australia, 2017Co-Authors: Yan Pan, Catriona Mclean, Rory Wolfe, Nikki R Adler, John W. KellyAbstract:OBJECTIVES To determine the frequency of naevus-associated Melanoma among Superficial Spreading and nodular subtypes; and to investigate associations between naevus-associated Melanoma and other clinico-pathological characteristics. DESIGN, SETTING AND PARTICIPANTS Cross-sectional study of all patients with nodular and Superficial Spreading Melanomas diagnosed between 1994 and 2015 at the Victorian Melanoma Service, Melbourne. METHODS AND MAIN OUTCOME MEASURES Clinical and pathological characteristics of naevus-associated and de novo Melanomas were assessed in univariable and multivariable logistic regression analyses. RESULTS Of 3678 primary Melanomas, 1360 (37.0%) were histologically associated with a naevus and 2318 (63.0%) were de novo Melanomas; 71 of 621 nodular (11.4%) and 1289 of 3057 Superficial Spreading Melanomas (42.2%) were histologically associated with a naevus. In multivariable analyses, the odds of being associated with a naevus were higher for Melanomas located on the trunk (v head and neck: adjusted odds ratio [OR], 2.27; 95% CI, 1.73-2.96; P < 0.001), while the odds were lower for thicker tumours (adjusted OR, 0.75 per millimetre increase in Breslow thickness; 95% CI, 0.69-0.81; P < 0.001), amelanotic/hypomelanotic Melanomas (adjusted OR, 0.68; 95% CI, 0.48-0.97; P = 0.035), and older age (patients 70 years or older v patients under 30 at diagnosis: adjusted OR, 0.28; 95% CI, 0.20-0.40; P < 0.001). After adjusting for confounders, the odds of an associated naevus was three times as high for Superficial Spreading Melanomas as for nodular Melanomas (adjusted OR, 3.05; 95% CI, 2.24-4.17; P < 0.001). CONCLUSION Melanomas are most likely to arise in the absence of a pre-existing naevus, particularly nodular Melanomas. Public health campaigns should therefore emphasise the detection of suspicious de novo lesions, as well as of changing lesions.
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An assessment of clinical pathways and missed opportunities for the diagnosis of nodular Melanoma versus Superficial Spreading Melanoma.
The Australasian journal of dermatology, 2015Co-Authors: Mark Cicchiello, Matthew J Lin, Yan Pan, Catriona Mclean, John W. KellyAbstract:Background Missed opportunities in the diagnosis of nodular Melanoma (NM) carry high prognostic penalties due to the rapid rate of NM growth. To date, an assessment of the pathways to diagnosis of NM versus Superficial Spreading Melanoma (SSM) specifically comparing numbers of opportunities missed to undertake biopsy has not been performed. Methods A retrospective questionnaire of 120 patients (60 NM patients, age and sex matched to 60 SSM patients) from the Victorian Melanoma Service (VMS) database was undertaken to assess pathways to diagnosis. The numbers of opportunities missed to undertake a biopsy and doctor behaviour at such encounters were recorded. Diagnostic delay (overall, patient's and doctor's delay) in terms of time was assessed. Results Significant differences in opportunities missed to make a diagnosis of NM compared to SSM were found. In all, 43% of NM were biopsied at a first encounter compared to 70% of SSM. All SSM were diagnosed within three reviews. Overall, 33% of NM required at least three and up six reviews until biopsy. Patients with NM were more likely than those with SSM to be reassured that their lesions were benign. No significant differences in terms of time delay to diagnosis between NM and SSM were found. Conclusions NM contributes disproportionately to Melanoma mortality in Australia. Addressing earlier diagnosis of NM with renewed focus may make the biggest impact on the overall mortality of Melanoma. The message that a period of observation is not appropriate for patients re-presenting with lesions of concern must be more effectively communicated.
John W. Kelly - One of the best experts on this subject based on the ideXlab platform.
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differences between pure desmoplastic Melanoma and Superficial Spreading Melanoma in terms of survival distribution and other clinicopathologic features
Journal of The European Academy of Dermatology and Venereology, 2019Co-Authors: John W. Kelly, Catriona Mclean, Matthew Howard, Edmund Wee, Rory Wolfe, Yan PanAbstract:BACKGROUND Pure desmoplastic Melanoma (pDM) is an uncommon subtype of malignant Melanoma with comparative high rates of local recurrence and low rates of sentinel lymph node positivity. The Melanoma-specific survival (MSS) of pDM compared to other Melanoma subtypes is unclear, with conflicting reports and lack of multivariable analyses. OBJECTIVES We aimed to describe clinicopathological characteristics of a cohort of patients with pDM and to compare the MSS of pDM with Superficial Spreading Melanoma (SSM). METHODS A prospective cohort study was performed of all primary invasive cutaneous pDM with known tumour location and thickness reviewed at a tertiary referral centre over 21 years. RESULTS A total of 119 primary cutaneous invasive pDMs from 3570 total invasive cutaneous Melanomas were included. Compared to 2272 SSMs, and due largely to their greater average thickness, patients with pDM had worse MSS (unadjusted hazard ratio, HR, 2.56, 95% confidence interval, CI, 1.56-4.22). After adjustment for clinicopathologic factors (including thickness, ulceration, mitotic rate, age and sex), there was evidence that patients with pDM had an improved MSS (adjusted HR, 0.49; 95% CI, 0.28-0.87). Median thickness of head and neck pDM was greater than non-head and neck pDM (P < 0.001). There was reduced univariable MSS in head and neck pDM compared to the rest of the body. CONCLUSIONS Decreased univariable MSS of patients with pDM compared to SSM was explained by the increased frequency of adverse clinicopathologic features at diagnosis, in particular the greater Breslow thickness of pDM. After adjustment, patients with pDM had half the chance of Melanoma-specific death compared to SSM. Head and neck pDM were thicker at diagnosis compared to the rest of the body, which may account for its poorer survival compared to the rest of the body.
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Differences between pure desmoplastic Melanoma and Superficial Spreading Melanoma in terms of survival, distribution and other clinicopathologic features.
Journal of the European Academy of Dermatology and Venereology : JEADV, 2019Co-Authors: Matthew Howard, John W. Kelly, Catriona Mclean, Edmund Wee, Rory Wolfe, Yan PanAbstract:BACKGROUND Pure desmoplastic Melanoma (pDM) is an uncommon subtype of malignant Melanoma with comparative high rates of local recurrence and low rates of sentinel lymph node positivity. The Melanoma-specific survival (MSS) of pDM compared to other Melanoma subtypes is unclear, with conflicting reports and lack of multivariable analyses. OBJECTIVES We aimed to describe clinicopathological characteristics of a cohort of patients with pDM and to compare the MSS of pDM with Superficial Spreading Melanoma (SSM). METHODS A prospective cohort study was performed of all primary invasive cutaneous pDM with known tumour location and thickness reviewed at a tertiary referral centre over 21 years. RESULTS A total of 119 primary cutaneous invasive pDMs from 3570 total invasive cutaneous Melanomas were included. Compared to 2272 SSMs, and due largely to their greater average thickness, patients with pDM had worse MSS (unadjusted hazard ratio, HR, 2.56, 95% confidence interval, CI, 1.56-4.22). After adjustment for clinicopathologic factors (including thickness, ulceration, mitotic rate, age and sex), there was evidence that patients with pDM had an improved MSS (adjusted HR, 0.49; 95% CI, 0.28-0.87). Median thickness of head and neck pDM was greater than non-head and neck pDM (P
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Nodular Melanoma is less likely than Superficial Spreading Melanoma to be histologically associated with a naevus
The Medical journal of Australia, 2017Co-Authors: Yan Pan, Catriona Mclean, Rory Wolfe, Nikki R Adler, John W. KellyAbstract:OBJECTIVES To determine the frequency of naevus-associated Melanoma among Superficial Spreading and nodular subtypes; and to investigate associations between naevus-associated Melanoma and other clinico-pathological characteristics. DESIGN, SETTING AND PARTICIPANTS Cross-sectional study of all patients with nodular and Superficial Spreading Melanomas diagnosed between 1994 and 2015 at the Victorian Melanoma Service, Melbourne. METHODS AND MAIN OUTCOME MEASURES Clinical and pathological characteristics of naevus-associated and de novo Melanomas were assessed in univariable and multivariable logistic regression analyses. RESULTS Of 3678 primary Melanomas, 1360 (37.0%) were histologically associated with a naevus and 2318 (63.0%) were de novo Melanomas; 71 of 621 nodular (11.4%) and 1289 of 3057 Superficial Spreading Melanomas (42.2%) were histologically associated with a naevus. In multivariable analyses, the odds of being associated with a naevus were higher for Melanomas located on the trunk (v head and neck: adjusted odds ratio [OR], 2.27; 95% CI, 1.73-2.96; P < 0.001), while the odds were lower for thicker tumours (adjusted OR, 0.75 per millimetre increase in Breslow thickness; 95% CI, 0.69-0.81; P < 0.001), amelanotic/hypomelanotic Melanomas (adjusted OR, 0.68; 95% CI, 0.48-0.97; P = 0.035), and older age (patients 70 years or older v patients under 30 at diagnosis: adjusted OR, 0.28; 95% CI, 0.20-0.40; P < 0.001). After adjusting for confounders, the odds of an associated naevus was three times as high for Superficial Spreading Melanomas as for nodular Melanomas (adjusted OR, 3.05; 95% CI, 2.24-4.17; P < 0.001). CONCLUSION Melanomas are most likely to arise in the absence of a pre-existing naevus, particularly nodular Melanomas. Public health campaigns should therefore emphasise the detection of suspicious de novo lesions, as well as of changing lesions.
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An assessment of clinical pathways and missed opportunities for the diagnosis of nodular Melanoma versus Superficial Spreading Melanoma.
The Australasian journal of dermatology, 2015Co-Authors: Mark Cicchiello, Matthew J Lin, Yan Pan, Catriona Mclean, John W. KellyAbstract:Background Missed opportunities in the diagnosis of nodular Melanoma (NM) carry high prognostic penalties due to the rapid rate of NM growth. To date, an assessment of the pathways to diagnosis of NM versus Superficial Spreading Melanoma (SSM) specifically comparing numbers of opportunities missed to undertake biopsy has not been performed. Methods A retrospective questionnaire of 120 patients (60 NM patients, age and sex matched to 60 SSM patients) from the Victorian Melanoma Service (VMS) database was undertaken to assess pathways to diagnosis. The numbers of opportunities missed to undertake a biopsy and doctor behaviour at such encounters were recorded. Diagnostic delay (overall, patient's and doctor's delay) in terms of time was assessed. Results Significant differences in opportunities missed to make a diagnosis of NM compared to SSM were found. In all, 43% of NM were biopsied at a first encounter compared to 70% of SSM. All SSM were diagnosed within three reviews. Overall, 33% of NM required at least three and up six reviews until biopsy. Patients with NM were more likely than those with SSM to be reassured that their lesions were benign. No significant differences in terms of time delay to diagnosis between NM and SSM were found. Conclusions NM contributes disproportionately to Melanoma mortality in Australia. Addressing earlier diagnosis of NM with renewed focus may make the biggest impact on the overall mortality of Melanoma. The message that a period of observation is not appropriate for patients re-presenting with lesions of concern must be more effectively communicated.
Giampiero Girolomoni - One of the best experts on this subject based on the ideXlab platform.
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clinical and diagnostic features of in situ Melanoma and Superficial Spreading Melanoma a hospital based study
Journal of The European Academy of Dermatology and Venereology, 2012Co-Authors: Paolo Rosina, Gianpaolo Tessari, M. V. Giordano, Giampiero GirolomoniAbstract:Background Despite the incidence of in situ Melanoma is continuously rising; few studies have investigated its clinical and diagnostic features. Objective To investigate clinical and diagnostic features of in situ Melanoma compared to Superficial Spreading Melanoma (SSM). Methods This is a hospital based, case-control study. Ninety consecutive patients with an in situ Melanoma and 90 age and gender matched patients with SSM were enrolled. Main outcome measures were differences in clinical signs that aroused suspicion of in situ Melanoma, detection modalities (self-detection vs. incidental detection by a physician), factors conditioning time between first noticing the suspect lesions and the physician visit. Results Median diameter of in situ Melanoma was smaller than SSM (7.5 vs. 9.0 mm, P < 0.024), and 47.8% of in situ Melanomas were smaller than 6 mm, in contrast to 25.6% of SSM (P < 0.002). In situ Melanoma was mainly detected by a dermatologist (Odds Ratio 2.95 P = 0.018), and in patients with more than 10 melanocytic naevi (Odds Ratio 3.12, P = 0.008). Clinical factors independently associated to early request of dermatological consultation were age older than 45 years (Odds ratio 3.47, P = 0.002) and location of lesion in a difficult observation skin site (Odds ratio 4.20, P = 0.001), but not Breslow’s thickness. Conclusions Our findings show that in situ Melanoma and SSM share similar clinical characteristics and early warning signs. However, in situ Melanoma is smaller in size than SSM. This may have important implications for early diagnosis and prevention strategies.
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Clinical and diagnostic features of in situ Melanoma and Superficial Spreading Melanoma: a hospital based study
Journal of the European Academy of Dermatology and Venereology : JEADV, 2011Co-Authors: Paolo Rosina, Gianpaolo Tessari, M. V. Giordano, Giampiero GirolomoniAbstract:Background Despite the incidence of in situ Melanoma is continuously rising; few studies have investigated its clinical and diagnostic features. Objective To investigate clinical and diagnostic features of in situ Melanoma compared to Superficial Spreading Melanoma (SSM). Methods This is a hospital based, case-control study. Ninety consecutive patients with an in situ Melanoma and 90 age and gender matched patients with SSM were enrolled. Main outcome measures were differences in clinical signs that aroused suspicion of in situ Melanoma, detection modalities (self-detection vs. incidental detection by a physician), factors conditioning time between first noticing the suspect lesions and the physician visit. Results Median diameter of in situ Melanoma was smaller than SSM (7.5 vs. 9.0 mm, P
Robert A. Schwartz - One of the best experts on this subject based on the ideXlab platform.
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Superficial Spreading Melanoma an analysis of 97 702 cases using the seer database
Melanoma Research, 2016Co-Authors: Parmvir Singh, Hee Jin Kim, Robert A. SchwartzAbstract:Superficial Spreading Melanoma (SSM) is the most common type of Melanoma. Large, population-based studies analyzing the incidence and survival of SSM are limited. This retrospective study was designed to evaluate demographic factors influencing the incidence and survival of SSM using a national population-based database. The United States National Cancer Institute's Surveillance, Epidemiology, and End Results registry was used to calculate incidence and disease-specific survival trends for SSM between 1973 and 2012. Patient data were stratified according to age, sex, race, ulceration, thickness, and stage. Of 97 702 patients, 52.66% were men, 94.93% were white, and 38.92% had a primary lesion on the trunk. The overall incidence is 5.987/100 000 and is increasing with an annual percentage change (APC) of 1.42%. Incidence increases with age, peaking at 70-79 years. Men (6.68/100 00, APC: 1.78) had a significantly higher incidence than women (5.565/100 000, APC: 1.10). A total of 79.16% of SSM are less than or equal to 1 mm and 92.32% are nonulcerated. The overall 5-year survival is 95.30% and is increasing steadily. Women (hazard ratio: 0.54), 'other' races (hazard ratio: 0.30), those with local disease, those with thin tumors, and those without ulceration had higher survival than their counterparts (P<0.0001). The incidence of this predominantly thin Melanoma subtype is on the rise, creating enhanced concern. Primary and secondary prevention techniques should consider the mortality associated with thin Melanoma.
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Superficial Spreading Melanoma: an analysis of 97 702 cases using the SEER database.
Melanoma research, 2016Co-Authors: Parmvir Singh, Hee Jin Kim, Robert A. SchwartzAbstract:Superficial Spreading Melanoma (SSM) is the most common type of Melanoma. Large, population-based studies analyzing the incidence and survival of SSM are limited. This retrospective study was designed to evaluate demographic factors influencing the incidence and survival of SSM using a national population-based database. The United States National Cancer Institute's Surveillance, Epidemiology, and End Results registry was used to calculate incidence and disease-specific survival trends for SSM between 1973 and 2012. Patient data were stratified according to age, sex, race, ulceration, thickness, and stage. Of 97 702 patients, 52.66% were men, 94.93% were white, and 38.92% had a primary lesion on the trunk. The overall incidence is 5.987/100 000 and is increasing with an annual percentage change (APC) of 1.42%. Incidence increases with age, peaking at 70-79 years. Men (6.68/100 00, APC: 1.78) had a significantly higher incidence than women (5.565/100 000, APC: 1.10). A total of 79.16% of SSM are less than or equal to 1 mm and 92.32% are nonulcerated. The overall 5-year survival is 95.30% and is increasing steadily. Women (hazard ratio: 0.54), 'other' races (hazard ratio: 0.30), those with local disease, those with thin tumors, and those without ulceration had higher survival than their counterparts (P
David K. Ahn - One of the best experts on this subject based on the ideXlab platform.
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Cutaneous Melanoma in Women III. Reproductive Factors and Oral Contraceptive Use
American journal of epidemiology, 1995Co-Authors: Elizabeth A. Holly, Rosemary D. Cress, David K. AhnAbstract:Oral contraceptive use and reproductive factors were investigated in a population-based case-control study of 452 women aged 25-59 years who were diagnosed with cutaneous malignant Melanoma during the period 1981-1986 and 930 controls. Ever use of oral contraceptives was reported by 72 percent of Melanoma patients and 79 percent of control subjects in this San Francisco Bay Area study, although duration of use was slightly longer for women with Superficial Spreading Melanoma (5.5 years) than for controls (4.3 years). While some subgroups had elevated or reduced odds ratios, no consistent association was observed between cutaneous Melanoma risk and oral contraceptive use when use was examined by duration, latency, age at diagnosis, age at first use, and time period of first use. Neither number of live births nor age at birth of the first child was associated with risk for cutaneous Melanoma; nor was a history of miscarriage, induced abortion, or endometriosis. No association was observed with regularity of menstrual periods or with use of fertility drugs or hormones to regulate menstrual periods. Women who reported experiencing hyperpigmentation of facial skin during a prior pregnancy had a lowered risk for all cutaneous Melanoma (odds ratio (OR) = 0.64, 95% confidence interval (CI) 0.44-0.93) and Superficial Spreading Melanoma (OR = 0.54, 95% CI 0.36-0.83). This effect was more pronounced for light-complexioned women (for Superficial Spreading Melanoma, OR = 0.37, 95% CI 0.20-0.70) than for women with a dark or medium complexion (for Superficial Spreading Melanoma, OR = 0.84, 95% CI 0.48-1.5). Women who reported use of acne medication also had a reduced risk of Superficial Spreading Melanoma (OR = 0.55, 95% CI 0.35-0.84). These results indicate an overall lack of effect of oral contraceptives on cutaneous Melanoma risk in this population of women. The reduced Melanoma risks associated with hyperpigmentation during a prior pregnancy and use of acne medication (or related hormonal indications for its use) should be studied further.
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Cutaneous Melanoma in women: Anatomic distribution in relation to sun exposure and phenotype
Cancer epidemiology biomarkers & prevention : a publication of the American Association for Cancer Research cosponsored by the American Society of Pre, 1995Co-Authors: Rosemary D. Cress, Elizabeth A. Holly, David K. Ahn, Philip E. Leboit, Richard W. SagebielAbstract:An analysis of the relationship between the anatomic site of cutaneous Melanoma, sun exposure, and phenotype was conducted in 355 women with histologically confirmed Superficial-Spreading Melanoma and in 935 control subjects. The most frequent site for Superficial-Spreading Melanoma was the leg. However, when major sun-related and phenotype risk factors were examined by site, risk ratios were lowest for Melanomas that occurred on the leg. A history of frequent sunburns during elementary or high school, increased number of self-assessed large nevi, and blond hair were more strongly associated with Melanoma sites other than the leg. Tumors on the trunk were more likely than tumors at other sites to be associated with histological evidence of a preexisting nevus. Results of this work indicate that associations between Melanoma phenotypic factors may differ by anatomic site.