Sex differences in survival from cutaneous melanoma

The prognosis for cutaneous melanoma is noticeably better in women than in men. The importance of male sex as an independent risk factor has recently been underscored in several studies using multivariate statistical models. The female superiority in survival is usually explained by the fact that the predominant site in women is the leg, compared with the trunk, which is the predominant location in men. Extremity melanomas have beter survival because of the predictability of the route of regional spread. Second, men often present with melanomas in a more advanced stage. Although these site and stage effects may be or principle importance, the matter of sex differences in survival from melanoma is more complex than is generally recognized. At least six factors, some of which appear to be interrelated, must be considered: location of the primary melanoma; stage of disease at presentation; endocrine factors; immunologic factors; pattern of metastatic spread (ie, lymphogenic versus hematogenic); and environmental and behavioral characteristics. The most relevant of these factors are discussed here.