Some Patients Need Closer Melanoma Screening

Ferrone CR, Porat LB, Panageas KS, et al. Clinicopathological features of and risk factors for multiple primary melanomas. JAMA. 2005;294:1647-1654.

Persons with an initial diagnosis of skin cancer are at increased risk for multiple primary melanomas (MPM), report Ferrone et al in JAMA. Family history (ie, a first-degree relative with a diagnosis of melanoma) and personal history of dysplastic nevi appear to be significant independent MPM risk factors. "[M]ore intensive dermatologic surveillance programs," rather than the standard lifelong annual follow-up, may be appropriate for patients with these risk factors, the authors conclude.

The researchers conducted a review of a prospectively updated database at Memorial Sloan-Kettering Cancer Center in New York City. They identified 4,484 patients who were diagnosed with an initial primary melanoma during the period from January 1996 through December 2002. Of this cohort, 385 subjects, or 8.6%, eventually developed MPM. One reason the incidence of MPM is not higher, the authors note, is that melanoma patients are more likely to die before developing a second primary tumor.

The cumulative five-year risk for development of a second primary tumor was 11.4%, and that for developing a third primary melanoma was 30.9%. In both cases, half of the risk occurred within the first year.

Most of the patients with MPM were male. The mean age at initial diagnosis was 61 (range, 11 to 89) for men and 52 (range, 20 to 90) for women. Women, however, had a longer duration between development of first and second primary melanomas than did men--possibly due to the fact that patients younger than 60 have a lower incidence of second primary melanoma than do their older counterparts.

Compared with persons who had a single primary melanoma (SPM), those with MPM were significantly more likely to have a positive family history of melanoma (12% and 21%, respectively). Similarly, a personal history of dysplastic nevi was seen more often in patients with MPM than in those with SPM (18% and 39%, respectively). Patients with both risk factors, however, were not at greater risk than those with either one.

In addition to closer monitoring, patients at increased risk for MPM "should also be further characterized genetically to further elucidate the biology and etiology of melanoma," the authors say.