Till death do us part: Love, marriage, and cutaneous oncology

By Warren R. Heymann, MD, FAAD
April 9, 2025
Vol. 7, No. 14

My wife asked me that question a year after finding a tick at the same site. This time, the dark lesion was a thin melanoma. I hadn’t a clue that a lesion was there.

Many studies confirm improved relative cancer survival among married patients, including untreated patients or those diagnosed in later stages of the disease. Married cancer patients generally have higher rates of early detection, treatment, and long-term survival. (1) The improved survival is not surprising. (In this commentary, I will use the terms “marriage,” “married,” “spouse,” or “partner” for any committed relationship between adults, regardless of legal status). A devoted partner will encourage a medical evaluation, necessary follow-up examinations, testing, and treatment.

For example, Taylor et al. analyzed the influence of marital status on the stage at presentation and disease-specific survival in patients with a sebaceous carcinoma.

Using the Surveillance, Epidemiology, and End Results (SEER) database, a total of 4,466 cases were identified (61.9% male), White (81.1%), ages 80+ (31.2%), and married (62.2%). There was a significant association between marital status and disease stage (P = .007); unmarried individuals were diagnosed with higher rates of regional (7.1% vs 4.8%) and distant stages (6.5% vs 4.5%), whereas married individuals exhibited higher rates of localized disease (90.7% vs 86.4%). Unmarried individuals were at higher odds of being diagnosed with regional/distant disease over localized disease compared with married individuals (odds ratio 1.50; P = .007). Married individuals demonstrated enhanced 5- and 10-year disease-specific survival (DSS 92.0% and 87.0%), respectively) compared with unmarried individuals (85.0% and 82.0%) (P < .001). Adjusting for age, sex, race and ethnicity, stage, tumor location, and income, unmarried status independently conferred an increased mortality risk (adjusted hazard ratio 1.59; P = .030).

Sharon et al. performed a retrospective, population-based study using the SEER database of 18 population-based registered cancer institutes to explore the association of marital status with T stage at presentation and management of early-stage melanoma. In this analysis of 52,063 patients, married patients more commonly presented with T1a tumors, whereas widowed patients were more likely to present with T4b tumors. Additionally, married patients were more likely to undergo sentinel lymph node biopsy for lesions with Breslow thickness greater than 1 mm. The authors concluded, “These findings support increased consideration of spousal training for partner skin examination and perhaps more frequent screening for unmarried patients, practical interventions with potentially significant clinical implications.” (3) Maas et al. studied 36,578 melanoma patients from the Florida Cancer Data System. Married patients, including both men and women, had a 35% reduction in the risk of death after melanoma diagnosis compared with single patients, suggesting that “mechanisms independent of earlier detection, such as social support, may play a role in survival in patients with melanoma.”

Xing et al. reviewed 3375 cases of mycosis fungoides (MF) from the SEER database. Married patients were more likely to be diagnosed at the T1 stage (p = 0.041) and were less likely to present with lymph node involvement (p = 0.007). More favorable overall survival (p < 0.001) and cancer‐specific survival (p < 0.001) were demonstrated in married patients as compared with divorced patients or widowed patients. Their conclusion: “Married marital status was associated with earlier stage at diagnosis and longer survival compared with divorced or widowed marital status in patients with MF.” (5)

The American Academy of Dermatology encourages self-advocacy through routine skin self-examination (SSE) and regular skin cancer screening by dermatologists for at-risk patients, who require routine physician screening. In a randomized clinical trial of 494 participants, Robinson et al demonstrated that SSE skills training for at-risk melanoma survivors and their skin check partners enabled pairs to assess moles and track concerning moles for change accurately. The patient population was 51.2% (253 of 494) female and had a mean age of 55 years. Patients in the intervention arms had significantly increased SSEs with their partners at 4, 12, and 24 months (P < .001 for all) compared with the control group. Patients in the intervention arms significantly identified new melanomas more than those in the control group [n = 51 melanomas in situ 18 invasive melanomas]. (6,7) Manne et al, in a survey of 184 married couples aged > years, found that couples who discussed SSE with one another were more likely to engage in it. (8)

My oldest daughter Andrea recently announced her engagement to her wonderful fiancé Matt. We are all looking forward to her wedding in November 2025. (My younger daughter Deborah married her devoted partner Christina in 2020.) The fundamental joy of having children get married is knowing (hoping) that they will have a lifelong partner for support in life’s travails, especially when we are no longer here. Melanoma was the second cancer my wife detected on me. In so many ways, I do not know where I would be without her.

Point to Remember: When partners encourage and assist in skin self-examinations, cancers are detected earlier, and prognosis improves.

Editor’s Note: Look for thoughts on full-body skin examinations next week.

Our expert’s viewpoint

June K. Robinson, MD, FAAD
Professor Emeritus of Dermatology
Northwestern University Feinberg School of Medicine

Even though early detection is crucial to improve patient and health system outcomes, population-wide screening is not considered economically feasible. Thus, screening for melanoma is recommended for those at risk to develop melanoma determined by genetic risk factors (nevus counts, presence of dysplastic nevi, skin color, family and personal history of melanoma or non-melanoma skin cancer) and behavioral attitudes and experiences with carcinogenic UV exposure. Often, the first person to notice a concerning lesion are the family and friends of a melanoma patient.

Opportunistic screening by family members and friends is mediated by awareness of the personal relevance of checking the skin for melanoma, and confidence in the ability to perform skin examination. Physicians can explain to partners that they can check areas people cannot see such as the top of a bald head, back of the neck and ears, and the back. Focusing on neutral areas that have less opportunity to be perceived as embarrassing can help a partner agree to try to check for melanoma. Training lay partners in the ABCDE rules of melanoma with physician reinforcement enhances confidence in their ability to “get it right.” (The AAD has flyers and posters, especially Check Your Partner, Check Yourself, to help with this.) Partner and patient education in melanoma early detection is often perceived by patients as demonstrating that the physician cares enough to go the extra mile.

Lastly, if your partner finds something suspicious remember to say thank you. Thank you, Warren, for sharing this experience with all of us. You reminded us to pay a bit more attention to patient and partner education in our practices

1. Merrill RM, Johnson E. Benefits of marriage on relative and conditional relative cancer survival differ between males and females in the USA. J Cancer Surviv. 2017 Oct;11(5):578-589. doi: 10.1007/s11764-017-0627-y. Epub 2017 Aug 2. PMID: 28770444.

2. Taylor MA, Thomas S, Wackel M, Sharma D, Wei EX. Influence of marital status on stage at presentation and disease-specific survival in sebaceous carcinoma: An analysis of the Surveillance, Epidemiology, and End Results database. J Am Acad Dermatol. 2024 Sep;91(3):576-578. doi: 10.1016/j.jaad.2024.05.055. Epub 2024 May 25. PMID: 38801979.

3. Sharon CE, Sinnamon AJ, Ming ME, Chu EY, Fraker DL, Karakousis GC. Association of Marital Status With T Stage at Presentation and Management of Early-Stage Melanoma. JAMA Dermatol. 2018 May 1;154(5):574-580. doi: 10.1001/jamadermatol.2018.0233. PMID: 29710174; PMCID: PMC6128501.

4. Maas JA, Monreal AJ, Diaz EL, Castro G, Rodriguez de la Vega P, Varella M. Marital Status and Survival in Patients Diagnosed with Melanoma. Dermatol Res Pract. 2020 Jan 30;2020:2485401. doi: 10.1155/2020/2485401. PMID: 32411190; PMCID: PMC7212327.

5. Xing LX, Zhang J, Shen H, Tang XL, He L, Wu JZ, Li JY, Miao Y. Association of marital status with stage and survival in patients with mycosis fungoides: A population-based study. Cancer Med. 2021 Oct;10(20):7320-7329. doi: 10.1002/cam4.4232. Epub 2021 Sep 4. PMID: 34480528; PMCID: PMC8525132.

6. Robinson JK. Skin check partner assistance for melanoma skin self-examination by at-risk patients: it takes two to identify melanomas. Future Oncol. 2020 Jun;16(16):1065-1068. doi: 10.2217/fon-2020-0265. Epub 2020 Apr 15. PMID: 32292057; PMCID: PMC7273363.

7. Robinson JK, Wayne JD, Martini MC, Hultgren BA, Mallett KA, Turrisi R. Early Detection of New Melanomas by Patients With Melanoma and Their Partners Using a Structured Skin Self-examination Skills Training Intervention: A Randomized Clinical Trial. JAMA Dermatol. 2016 Sep 1;152(9):979-85. doi: 10.1001/jamadermatol.2016.1985. PMID: 27367303; PMCID: PMC5490386.

8. Manne SL, Coups EJ, Kashy DA. Relationship factors in skin self-examination among couples. Br J Health Psychol. 2016 Sep;21(3):631-47. doi: 10.1111/bjhp.12190. Epub 2016 Mar 24. PMID: 27009696.