Are malignant melanoma patients at higher risk for a second cancer?

Abstract

This study tests whether malignant melanoma (MM) patients are at higher risk of having an unrelated second cancer by comparing the observed incidence of a second cancer in a given population of MM patients with the expected number in an age-matched and sex-matched group of healthy people followed for a similar period. The analysis was based on the person-years method in which the main consideration is the follow-up period after the diagnosis of MM. Of 370 patients with histologically confirmed MM, 27 (7.3%) had a second noncutaneous invasive cancer, diagnosed either simultaneously (within 6 months, five patients) or after the diagnosis of MM (22 patients). The follow-up period for the entire MM group was 1253 person-years, a period during which the expected number of cancer cases in the normal population, according to the Israel Cancer Registry, was 6.6. The observed-expected ratio or the relative risk (RR) was 4.1 (P less than 0.01). After excluding the five patients with simultaneous diagnosis of MM and a second cancer, analysis of the remaining 22 patients in whom MM definitely preceded the second cancer showed an RR of 3.3 (P less than 0.01). For the entire group, there were nine patients with breast cancer, five with head and neck cancer (two with thyroid and three with oral cavity cancer), five with gynecologic cancer (one with uterine and four with ovarian cancer), five myeloproliferative malignancies (one with lymphoma, three with chronic lymphocytic leukemia, and one with myeloma), three gastrointestinal carcinomas (two with colon and one with stomach cancer), and two soft tissue sarcomas. When the differential analysis according to gender and age was done, it was found that the RR was higher for women (5.5, P less than 0.01) than for men where the RR was 2.2 (P less than 0.05). Differential analysis for various age groups showed that the trend for second cancer was consistent in all age groups, with a slight increase in the younger ones. None of the variables of MM, such as location of the primary tumor, level of invasion, or stage, were predictive for a second cancer. Furthermore, the RR for a second cancer did not relate significantly with the treatment given to the MM patient. Concerning the type of second cancer, it was found that the RR was especially high for breast cancer--6.6. These data indicate that MM patients may be at higher risk for having a noncutaneous invasive cancer compared with the general population.

Evidence for an association between cutaneous malignant melanoma and lymphoid malignancy: a population-based retrospective cohort study in Scotland

“…The association between CM and other cancer is controversial, but clarification of these relations may lead to an improved understanding of aetiology. Several studies reporting an overall increased incidence of a second primary tumour among CM survivors have been small hospital-based case series or with short follow-up periods or included nonmelanoma skin cancer as a second primary (Adami et al, 1995;Swerdlow et al, 1995;Wassberg et al, 1996;Bhatia et al, 1999); the type of secondary tumour reported has been inconsistent (Gutman et al, 1991;Riou et al, 1995;McKenna et al, 2000).…”

Second primary cancers in patients with cutaneous malignant melanoma: a population-based study in Sweden

“…However, the proportions of patients having a second primary cancer vary widely from 1.5% up to 20% and comparisons between the studies are difficult owing to differences in the length of follow-up (Fraser et al, 1971;Fletcher, 1973;Boland et al, 1976;Teppo et al, 1985;Tucker et al, 1985a;Gutman et al, 1991;Schallreuter et al, 1993). Previous studies suggest associations between malignant melanoma and an array of different specific types of cancer, such as tumours of the nervous system (Teppo et al, 1985;Tucker et al, 1985a), non-melanoma skin cancer (Fraser et al, 1971;Fletcher, 1973;Lindelof et al, 1991), Hodgkin's disease (Tucker et al, 1985b), non-Hodgkin's lymphoma (Teppo et al, 1985), leukaemia (Boland et al, 1976;Teppo et al, 1985), cancers of the breast (Boland et al, 1976;Schoenberg and Christine, 1980;Gutman et al, 1991;Schallreuter et al, 1993), ovary (Boland et al, 1976), endometrium (Tucker et al, 1985a), testis (Teppo et al, 1985) and tumours of the digestive tract (Bergman et al, 1990). Taken together, these earlier observations may fit into different hypotheses based on similar risk factors in malignant melanoma and other specific cancers.…”

Biologically Based Epidemiological Studies of Electric Power and Cancer

“…Among 370 patients diagnosed with malignant melanoma who were followed prospectively, a second primary cancer of breast later developed at a rate six times that expected (71), which suggests a common etiology for melanoma and breast cancer that may involve reduced melatonin. Melatonin has been reported to slow the growth of transplanted melanoma cells in athymic mice (72).…”