Survival Superiority of Females With Melanoma

We read with interest the article by Stidham et al¹ in which they claim to have demonstrated a female superiority in survival from melanoma, particularly because they had previously failed to do so.² The Sydney Melanoma Unit has had a continuing interest in this question for many years but this article failed to convince us of such a superiority for three important reasons.

First, no attempt was made to group patients according to pathologic stage of disease at first presentation—the factor that is indisputably the most dominant predictor of survival from melanoma. Data from several major melanoma centers worldwide (including Duke University Medical Center in Durham, NC) show a preponderance of women first presenting with stage I and II disease (AJCC/UICC pathologic pTNM system) and a preponderance of men first presenting with stage III disease.² Because women have less advanced disease at first presentation, this obviously bestows