A NATIONWIDE Swedish study has revealed that patients with localised stage IIC melanoma experience significantly worse melanoma-specific survival than those with lymph node involvement in stage IIIA. The findings suggest that current follow-up recommendations may need revision to better address the risks faced by patients with thick, localised melanoma.
The research analysed data from 5,815 adults diagnosed with stage II–III cutaneous melanoma between 2001 and 2018. Using linked data from the Swedish Melanoma Register, the National Cause of Death Register, and other population-based sources, the team evaluated clinicopathological characteristics, comorbidities, socioeconomic factors, and 10-year melanoma-specific survival across substages.
Melanoma Survival in Stage IIC versus Stage IIIA
Survival analysis revealed striking differences between melanoma stages. Ten-year melanoma-specific survival rates were stage IIA 86%, IIB 73%, IIC 61%, IIIA 78%, IIIB 56%, IIIC 43%, and IIID 19%. Notably, patients with stage IIC melanoma had lower survival than stage IIIA patients despite not having lymph node involvement.
Demographically, stage IIC patients were older (median age 70 vs. 55 years), more likely to be male (59.2% vs. 51.5%), had more comorbidities such as hypertension and type 2 diabetes, and lower socioeconomic status than stage IIIA patients. Regression analyses indicated that age, sex, and tumour thickness partly explained survival differences; however, even after adjusting for these factors, stage IIC remained associated with poorer outcomes.
Implications for Follow-Up and Treatment Guidelines
The study’s findings challenge current Swedish guidelines, which recommend less frequent follow-up for stage II compared with stage III melanoma. Given the poorer prognosis of stage IIC patients, the authors suggest that this group may benefit from closer monitoring and more aggressive management strategies.
These results highlight the heterogeneity within melanoma stages and underscore the importance of tailored follow-up and treatment plans. Specifically, thick, localised melanomas (stage IIC) warrant increased clinical attention, as survival outcomes are worse than some patients with lymph node metastases in stage IIIA.
Overall, this study emphasises the need to reconsider current clinical guidelines and improve treatment approaches for patients with high-risk, localised melanoma, ensuring that follow-up and management strategies are aligned with actual survival risks rather than stage classification alone.
Reference
Marjanovic M et al. Contrasting Survival Outcomes and Patient Characteristics in 5,815 Patients with Stage II and III Melanoma: A Nationwide Population-Based Registry Study from Sweden. Br J Dermatol. 2025; doi:10.1093/bjd/ljaf478.
