Smoking is an Independent Marker of Poor Prognosis in Cutaneous Melanoma

Previous studies have suggested that persistent tobacco smoking impairs survival in cutaneous melanoma, but the effects of smoking and other prognostic factors have not been described in detail. This study examined the association of smoking (persistent, former, or never) with melanoma-specific (MSS) and overall survival (OS) in patients with cutaneous melanoma treated in Southwest Finland during 2005 to 2019. Clinical characteristics were obtained from electronic health records for 1,980 patients. Smoking status was available for 1,359 patients. Patients were restaged according to the 8(th) edition of the tumour-node-metastasis (TNM) classification. Smoking remained an independent prognostic factor for inferior melanoma-specific survival regardless of age, sex, stage, and comorbidities. The hazard ratio of death from melanoma was 1.81 (1.27−2.58, p = 0.001) in persistent and 1.75 (1.28−2.40, p = 0.001) in former smokers compared with never smokers. In 351 stage IV patients, smoking was associated with increased melanoma-specific and overall mortality: median MSS 10.4 (6.5−14.3), 14.6 (9.1−20.1), and 14.9 (11.4−18.4) months, p = 0.01 and median OS 10.4 (6.5−14.3), 13.9 (8.6−19.2), and 14.9 (11.7−18.1) months, p = 0.01 in persistent, former, and never smokers, respectively. In conclusion, since smoking represents an independent modifiable poor prognostic factor in patients with cutaneous melanoma, smoking habits should be proactively asked about by healthcare professionals, in order to support smoking cessation. SIGNIFICANCE Earlier studies have suggested that smoking impairs survival in patients with cutaneous melanoma, but the effect of smoking, along with other established prognostic factors, has not been described in detail. This study examined the association of smoking status (persistent, former, or never) with survival in patients with cutaneous melanoma treated in Southwest Finland in 2005 to 2019. Smoking was an independent prognostic factor for shorter survival after adjustment for other risk factors, including age, sex, TNM stage, and comorbidities. The detrimental effect of smoking on survival was most marked in patients with metastatic melanoma and these patients should routinely be supported to stop smoking.