Multiple primary melanoma

Abstract

From a series of 712 patients with melanoma, 38 patients (5.3%) had more than one primary melanoma. Twenty-four patients had two primaries, 11 patients had three, 2 patients had four, and l patient had eight. Twelve patients (32%) had one or more synchronous primaries. Forty-five percent of all multiple primaries were diagnosed within the first year. Microstaging by level and depth was determined prior to treatment and in patients with nonsynchronous primaries, 83% had a subsequent melanoma equal or less advanced than the original. Twenty-six patients with Stage I primaries were skin-tested with DNCB prior to therapy. No significant differences in delayed cutaneous hypersensitivity reactions were found between multiple primary and matched controls with only a single melanoma. Four of 10 patients with multiple primaries treated with adjuvant BCG or BCG-tumor cell vaccine developed subsequent melanomas suggesting that immunotherapy with BCG will not prevent the development of a new primary melanoma. Survival in patients with Stage I and I1 multiple primary melanomas was improved compared to Stage I and I1 patients with a single primary. This study suggests that prognosis in multiple primary melanomas is better reflected by the most advanced primary based on microstaging and the presence or absence of regional lymph node metastases than by multiplicity.Cancer 43:939-944, 1979.

Ultra‐late recurrence (15 years or longer) of cutaneous melanoma

“…Thus, the miniThe study data differed from the reported observations on several points. In contrast to the authors' findings, mum rate of ultra-late recurrence can be calculated to be 2.0% (20 though these women were also younger than their not the tendency for women to recur with regional involvement. From the literature, 64% of patients with male counterparts at the time of their primary diagnosis (36.6 years vs. 41.0 years), the disparity in age was lower extremity lesions had regional recurrence whereas all patients with truncal melanomas had disnot as great as that observed with patients in the current study.…”

Single versus multiple primary melanomas

“…3,6,7,9,12,[15][16][17][18][19][20] A study from the John Wayne Cancer Institute examined the first 2 primary melanomas in 114 patients with MPM who were identified from a melanoma database and demonstrated that there were significant differences between AJCC stage, mean tumor thickness, and Clark level of invasion between the first and second melanomas, and the second melanoma was thinner. 21 Our results indicating that the thickness of the first primary melanoma is significantly greater compared with the thickness of the second melanoma are consistent with previously reported findings.…”

“…Some investigators have observed a better prognosis in patients who have MPM compared with patients who have SPM. 3,4,23 In a retrospective analysis on 5250 patients with melanoma that was controlled for known prognostic factors as well as ''survival bias'' (because patients who survive longer have the opportunity to develop additional tumors), the authors observed that patients who had !3 primary melanomas had longer survival than patients who had a single primary melanoma. 23 In another study, Ferrone et al suggested that less aggressive disease biology may be the reason for a higher percentage of disease-specific deaths in patients with SPM than in patients with MPM and also may be the reason for significantly thinner initial melanomas in patients with MPM versus patients with SPM.…”

“…1,2 Various single-center and population-based studies have reported that between 1.2% and 8.6% of patients who have a history of melanoma will develop subsequent melanomas. [3][4][5][6][7][8][9][10][11][12] Several risk factors for the development of more than 1 primary melanoma have been established, the most important of which include a family history of melanoma and a personal history of dysplastic nevi. 10,[12][13][14] The initial melanoma in patients who have multiple primary melanomas (MPM) usually is the thickest of the melanomas that eventually develop.…”

“…10,[12][13][14] The initial melanoma in patients who have multiple primary melanomas (MPM) usually is the thickest of the melanomas that eventually develop. 3,6,7,9,12,[15][16][17][18][19][20][21] The 2 competing explanations for this trend include early detection of subsequent melanomas and less aggressive tumor biology in patients with MPM. Supporting the early detection hypothesis, a 2010 retrospective study by de Giorgi et al suggested that patients with MPM who did not adhere to regular follow-up had significantly thicker melanomas than patients who attended regular follow-up (mean thickness, 1.22 mm vs 0.36 mm).…”