Vitamin D deficiency is associated with a worse prognosis in metastatic melanoma

// Dmitriy Timerman 1 , Melissa McEnery-Stonelake 2 , Cara J. Joyce 3 , Vinod E. Nambudiri 4 , F. Stephen Hodi 5 , Elizabeth B. Claus 6 , Nageatte Ibrahim 5, 7 Jennifer Y. Lin 4, 5 1 Harvard-MIT Health Sciences and Technology (HST), Harvard Medical School, Boston, MA, USA 2 Department of Dermatology, University of Alabama at Birmingham, Birmingham, AL, USA 3 Department of Biostatistics, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA 4 Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA 5 Melanoma Program, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA 6 Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA 7 Merck Research Laboratories, Clinical Oncology, North Wales, PA, USA Correspondence to: Jennifer Y. Lin, email: jylin@partners.org Keywords: vitamin D deficiency, melanoma, 25(OH)D3 Received: June 20, 2016 Accepted: December 05, 2016 Published: December 28, 2016 ABSTRACT Vitamin D deficiency (≤20 ng/mL) is associated with an increased incidence and worse prognosis of various types of cancer including melanoma. A retrospective, single-center study of individuals diagnosed with melanoma from January 2007 through June 2013 who had a vitamin D (25(OH)D3) level measured within one year of diagnosis was performed to determine whether vitamin D deficiency and repletion are associated with melanoma outcome. A total of 409 individuals diagnosed with histopathology-confirmed melanoma who had an ever measured serum 25(OH)D3 level were identified. 252 individuals with a 25(OH)D3 level recorded within one year after diagnosis were included in the study and the individual and melanoma characteristics such as age, sex, Breslow thickness, ulceration, stage, mitotic rate, and LDH were obtained from the medical record. A worse melanoma prognosis was associated with vitamin D deficiency (P=0.012), higher stage (P<0.001), ulceration (P=0.001), and higher mitotic rate (P=0.001) (HR 1.93, 95% CI 1.15-3.22). In patients with stage IV metastatic melanoma, vitamin D deficiency was associated with significantly worse melanoma-specific mortality (adjusted HR 2.06, 95% CI 1.10-3.87). Patients with metastatic melanoma who were initially vitamin D deficient and subsequently had a decrease or ≤20 ng/mL increase in their 25(OH)D3 concentration had significantly worse outcomes (HR 4.68, 95% CI 1.05-20.88) compared to non-deficient patients who had a >20 ng/mL increase. Our results suggest that initial vitamin D deficiency and insufficient repletion is associated with a worse prognosis in patients with metastatic melanoma.