Body composition and melanoma incidence risk: insights from a longitudinal lung cancer screening cohort
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Objective
This study explored the association between low-dose computed tomography (LDCT)-derived body composition and melanoma incidence risk.
Methods
LDCT scans from the Pittsburgh Lung Screening Study (n=3,422, 22 follow-up years) were analyzed. Body composition features were segmented and quantified from baseline scans using in-house artificial intelligence algorithms. Features were selected before modeling. Fine-Gray subdistribution hazard models assessed the association between body composition and melanoma incidence. Model performance was evaluated using time-dependent area under the curve (AUC). Restricted mean survival time (RMST) compared melanoma-free survival across BMI and body composition groups at 5, 10, and 15 years. Participants were stratified into risk groups, with risk estimated at each time point. Sex-specific analyses were conducted separately. Statistical significance was defined as p<0.05.
Results
Among 3,422 participants, 80 developed melanoma (43 males, 37 females). In the overall model, visceral adipose tissue ( VAT ) volume (hazard ratio [HR]=1.27), skeletal muscle ( SM ) density (HR=0.81), and bone density (HR=1.33) were included, achieving a 21-year AUC of 0.68 (95% CI: 0.65–0.70). The male-specific model included only SM density (HR=0.74; AUC=0.67, 95% CI: 0.65–0.68). The female-specific model (AUC=0.68, 95% CI: 0.65–0.71) included VAT volume (HR=1.47), intramuscular adipose tissue ( IMAT ) ratio (HR=0.67), and bone density (HR=1.75). Higher VAT, IMAT volume , and lower SM density showed shorter melanoma-free survival and stratified risk better than BMI. Males exhibited higher estimated risk than females.
Conclusion
LDCT-derived body composition metrics may provide incidental insights into melanoma risk during lung cancer screening, though their predictive utility remains limited and warrants further investigation.
Key Points
Question
To investigate the association between CT-derived three-dimensional (3D) body composition and the risk of developing melanoma.
Findings
CT-derived body composition was associated with melanoma incidence. Males demonstrated higher estimated risk than females over both short- and long-term follow-up periods.
Clinical Relevance
Given melanoma’s high mortality and the limited effectiveness of current screening programs, these findings highlight the potential of leveraging routinely acquired lung cancer screening CT scans to enhance melanoma risk assessment.
