Smoking and Melanoma Outcomes—Another Reason to Quit

Menée à partir des données de deux essais portant sur 6 279 patients atteints d'un mélanome cutané de stade précoce (âge moyen : 52,7 ans ; hommes : 57,9 %), cette étude évalue l'association entre le statut tabagique et la survie des patients

Résumé en anglais

Do you need another reason to encourage your patients to stop smoking? Smoking increases the risk of a myriad of diseases and is associated with cancer incidence and mortality. Smoking increases the risk of dying of cancer of the lung, oropharynx, pancreas, bladder, and cervix, to name just a few. Jackson and colleagues found that a substantial proportion of patients (1077 of 6279 patients [17.2%]) who presented with clinically localized melanoma were current smokers. Perhaps this is an ideal moment to recommend against smoking because the diagnosis of melanoma, in my experience, has often been a teachable moment. Many patients dramatically alter their sun exposure habits, returning for follow-up visits without a trace of sunburn or tan (even in the summer months), despite a lack of evidence that modification of this behavior is associated with long-term outcomes for melanoma. While it is certainly not as addictive as nicotine, UV exposure shares features of addiction as well. Jackson and colleagues use the data from 2 large, well-conducted clinical trials in patients with clinically localized melanoma to determine the association of smoking with melanoma-specific survival (MSS) and melanoma-associated death (MAD). The Multicenter Selective Lymphadenectomy Trials (MSLT-I and MSLT-II) provided the data and were conducted to determine whether sentinel lymph node (SLN) biopsy was associated with improved MSS compared with wide excision and observation (MSLT-I) and whether completion node dissection in patients with SLN-positive melanoma was associated with MSS advantage compared with nodal basin observation (MSLT-II). These 2 trials were practice-changing (neither study found an association) and provided the foundation for the current treatment of patients with clinically localized melanoma or microscopic regional nodal disease.