Prognostic Impact of Detection Patterns, Reasons for Consultation, and Sex Differences in Melanoma Among Young Adults: A 30-Year Retrospective Cohort Study.

BACKGROUND: Melanoma in young adults causes substantial years of life lost because deaths occur early. Detection pathways, reasons for consultation, and sex differences may influence tumor thickness and prognosis, but evidence in this age group remains limited. METHODS: We conducted a retrospective cohort study of patients aged 18-44 years with primary cutaneous melanoma diagnosed between 1993 and 2022, with a median follow-up of 142 months. Detection source was classified as self, relatives/friends, or healthcare professionals, and reasons for consultation were recorded for self-detected cases. Outcomes included Breslow thickness (> 2 mm), metastasis, melanoma-related death, survival, and years of life lost. Multivariable logistic regression, Kaplan-Meier analyses, and exploratory Cox regression were performed. RESULTS: Among 316 patients, self-detection was the most common pathway (58.9%). Thick melanoma was more frequent in self-detected cases than in those detected by relatives or healthcare professionals (p = 0.003). Male sex and self-detection were independently associated with thick melanoma. Among self-detected cases, nodularity and bleeding were the strongest predictors. Men had higher metastatic progression (33.1% vs. 18.1%, p = 0.002) and melanoma-related mortality (18.7% vs. 11.3%, p = 0.049). Median years of life lost among melanoma deaths was 29.15 years. CONCLUSIONS: In young adults, melanoma prognosis is strongly linked to detection pathway, consultation triggers, and sex. Earlier professional evaluation, especially in young men and in lesions with high-risk features, may reduce advanced disease and years of life lost.