Advertisement

Annals of Surgical Oncology

, Volume 6, Issue 7, pp 705–711 | Cite as

Increased Incidence of Second Primary Melanoma in Patients With a Previous Cutaneous Melanoma

  • L. Andrew DiFronzo
  • Leslie A. Wanek
  • Robert Elashoff
  • Donald L. Morton
Best Clinical Research Paper

Abstract

Background: Patients with cutaneous melanoma reportedly have an increased risk of developing second primary melanoma; however, this increased risk has not been well characterized with respect to age and time from first melanoma. We hypothesized that, as a result of temporal variations in environmental exposure, genetic susceptibility, and impaired immune competence, the incidence of second primary melanoma varies significantly with respect to age and time.

Methods: A review of our prospective melanoma data base, containing records for 8928 patients, was undertaken to identify patients with American Joint Committee on Cancer stage I and II cutaneous melanoma, who were treated from 1971 to 1998.

Results: Second primary melanoma was identified in 113 (3.4%) of 3310 patients with American Joint Committee on Cancer stage I and II cutaneous melanoma. In 11 patients (0.3%), the second melanoma was identified within 2 months of the initial tumor; the remaining 102 patients had a metachronous lesion. The incidence rate of second primary melanoma was 325 per 100,000. The standardized incidence ratio, defined as the ratio of the number of observed second melanomas to the number of expected melanoma cases, was 25.6. The 5- and 10-year risk of developing a second melanoma was 2.8% and 3.6%, respectively. Both the annual risk of developing a second melanoma and the standardized incidence ratio were elevated in younger patients (ages 15–39 years) and in older patients (ages 65–79 years).

Conclusions: Patients with cutaneous melanoma are at very high risk for development of second primary melanoma. This risk approximates 0.5% per year for the first 5 years of follow-up. Patients aged 15–39 and patients aged 65–79 have a particularly high incidence of second melanoma, suggesting different causes for the development of second primaries. All patients with melanoma should undergo careful surveillance for second melanomas in addition to routine screening for recurrence.

Key Word

Melanoma Multiple primary sites Incidence 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

REFERENCES

  1. 1.
    Landis SH, Murray T, Bolden S, Wingo PA. 1998 Cancer statistics 1998. CA Cancer J Clin 48:6–29.PubMedGoogle Scholar
  2. 2.
    Ries LAG, Kosary CL, Hankey BF, Miller BA, Edwards BK, eds. 1998 SEER cancer statistics review, 1973–1995. National Cancer Institute Bethesda, MD,Google Scholar
  3. 3.
    Wassberg C, Thorn M, Yuen J, Ringborg U, Hakulinen T. 1996 Second primary cancers in patients with cutaneous malignant melanoma: A population-based study in Sweden. Br J Cancer 73:255–259.Google Scholar
  4. 4.
    Veronesi U, Cascinelli N, Bufalino R. 1976 Evaluation of the risk of multiple primaries in malignant cutaneous melanoma. Tumori 62:127–130.Google Scholar
  5. 5.
    Brobeil A, Rapaport D, Wells K, et al. 1997 Multiple primary melanomas: Implications for screening and follow-up programs for melanoma. Ann Surg Oncol 4:19–23.Google Scholar
  6. 6.
    Delfino C, Caccia G, Hidalgo J, Bosch B. 1998 Association between malignant melanoma and other primary malignancies [Abstract]. Proc Am Soc Clin Oncol 17:2130.Google Scholar
  7. 7.
    Levi F, LaVecchia C, Randimbison L, Te VC, Erler G. 1997 Incidence of invasive cancers following cutaneous malignant melanoma. IntJ Cancer 72:776–779.Google Scholar
  8. 8.
    Savoia P, Quaglino P, Verrone A, Bernengo MG. 1998 Multiple primary melanomas: Analysis of 49 cases. Melanoma Res 8:361–366.Google Scholar
  9. 9.
    Schoenberg BS, Myers MH. 1977 Statistical methods for studying multiple primary malignant neoplasms. Cancer 40:1892–1898.Google Scholar
  10. 10.
    Reintgen DS, Cox C, Slingluff C, Seigler HF. 1992 Recurrent malignant melanoma: The identification of prognostic factors to predict survival. Ann Plast Surg 28:45–49.Google Scholar
  11. 11.
    Monzon J, Liu L, Brill H, et al. 1998 CDKN2A mutations in multiple primary melanomas. N Engl J Med 338:879–887.Google Scholar
  12. 12.
    Lehtonen L, Eskola J, Vainio O, Lehtonen A. 1990 Changes in lymphocyte subsets and immune competence in very advanced age. J Gerontol 45:M108–M112.Google Scholar
  13. 13.
    Thivolet J, Nicolas JF. 1990 Skin ageing and immune competence. Br J Dermatol 122(Suppl 35):77–81.Google Scholar
  14. 14.
    Moseley HS, Giuliano AE, Storm FK, Clark WH, Robinson DS, Morton DL. 1979 Multiple primary melanoma. Cancer 43:939–944.Google Scholar

Copyright information

© The Society of Surgical Oncology, Inc. 1999

Authors and Affiliations

  • L. Andrew DiFronzo
    • 1
  • Leslie A. Wanek
    • 2
  • Robert Elashoff
    • 2
  • Donald L. Morton
    • 1
    • 2
  1. 1.Roy E. Coats Research Laboratories of the John Wayne Cancer Institute at Saint John’s Health CenterSanta Monica
  2. 2.John Wayne Cancer InstituteSanta Monica

Personalised recommendations