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

Abstract

Summary To quantify the risk of second primary cancers among patients with cutaneous malignant melanoma, we studied 20 354 patients in the Swedish Cancer Register during 1958-88. A second primary cancer was reported in 1605 patients, compared with an expected number of 1109.5 [standardised incidence ratio (SIR) = 1.45, 95% confidence interval (CI) = 1.38-1.52]. The highest risk was found among patients younger than 60 years. The greatest risk was seen during the first year after diagnosis (SIR = 1.91, CI = 1.69-2.14), but even after long-term follow-up -15 years or more -the risk was still significantly elevated (SIR = 1.56, CI = 1.35-1.79). The strongest association was found for a second primary malignant melanoma (men, SIR = 10.0, CI = 8.26-12.00; women, SIR = 8.66, CI = 7.22-10.30) and non-melanoma skin cancer (men, SIR = 3.58, CI = 2.85-4.44; women, SIR = 2.41, CI = 1.71-3.29). The risk of second cancers associated with tissues of neuroectodermal origin was increased, especially tumours of the nervous system (men, SIR = 1.73, CI = 1.10-2.60; women, SIR = 2.03, CI = 1.45-2.78). The SIR of second cancers involving the immune system was also increased. An excess risk of endometrial cancer was seen (SIR = 1.41, CI = 1.03-1.88), but no significant associations existed for cancers of the breast, ovary, testis or other endocrine glands. Among tumours of the digestive tract, only colon cancer in men had a significantly increased SIR (1.33, CI = 1.00-1.74).

Site-specific occurrence of nonmelanoma skin cancers in patients with cutaneous melanoma

“…This strong association was not unexpected and is similar in magnitude to risks reported in other European record linkage studies (Wassberg et al, 1996;Levi et al, 1997a;Kroumpouzos et al, 2000;Hemminki et al, 2003;Crocetti and Carli, 2004).…”

“…Patients with melanoma are known to be at a substantially increased risk of the nonmelanoma skin cancers (NMSC) BCC and SCC (Wassberg et al, 1996;Levi et al, 1997a;Hemminki et al, 2003;Crocetti and Carli, 2004) and the converse is also true (Levi et al, 1997b(Levi et al, , 1998Wassberg et al, 1999;Bower et al, 2000;Maitra et al, 2005). However, it is not known whether the association between melanoma and NMSC varies according to the anatomical site.…”

The non-Hodgkin lymphomas: A review of the epidemiologic literature

“…646 Nonsignificant associations among men (SIR 5 1.37, 95% CI: 0.84-2.12) and women (SIR 5 1.26, 95% CI: 0.75-2.00) were reported with history of CMM. 645 Possible explanations for the positive associations that have been observed include inherited susceptibility to malignancy, exposure to an agent that is causally associated with both cancers, or an immunosuppressive or direct effect resulting from chemotherapy or radiation. It is unclear whether a history of any malignancy is a useful classification or whether associations with individual cancer types should be evaluated separately, since malignancies vary widely in their etiology and treatment.…”

“…643 An increased risk of developing NHL following a diagnosis of breast cancer was reported in a cohort study of Japanese women (RR 5 3.5, 95% CI: 1.4-7.1). 644 Wassberg et al 645,646 evaluated the subsequent risk of NHL among persons diagnosed with squamous cell carcinoma (SCC) of the skin or cutaneous malignant melanoma (CMM). An increased relative risk of NHL (SIR 5 1.9, 95% CI: 1.6-2.3) was observed after SCC; however, this excess occurred only within 4 years after SCC diagnosis.…”

Incidence of cancer in first-degree relatives of basal cell carcinoma patients

“…Patients who have BCC have an increased occurrence of second primary tumours of head and neck, bladder, larynx, lung and colon as well as non-Hodgkin's lymphoma and melanoma [11,23,27]. Besides, the incidence of second primary cancers of head and neck, thyroid, lung, larynx, bladder, colon, as well as cutaneous malignant melanoma, non-Hodgkin's lymphoma and leukemias are increased after NMSC appearance.…”