Survival and tumor characteristics of patients presenting with single primary versus second primary melanoma lesions

Sarver, Melissa M.; Rames, Jess D.; Beasley, Georgia M.; Gao, Junheng; Jung, Sin‐Ho; Chen, Shuo

doi:10.1016/j.jaad.2022.04.046

Cited by 2 publications

(9 citation statements)

References 19 publications

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“…In relation to the clinical characteristics of first and subsequent melanomas, our findings are consistent with previous research reporting that second (or higher-order) melanomas are, on average, thinner than first melanomas, and more likely to be in situ . Clinical practice guidelines recommend periodic screening for patients after a diagnosis of melanoma; the frequency of screening is guided by the characteristics of the primary tumor, including Breslow thickness, stage, presence of ulceration, and number of mitoses.…”

Section: Discussionsupporting

confidence: 89%

Risk Factors Associated With First and Second Primary Melanomas in a High-Incidence Population

et al. 2023

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ImportanceAn increasing number of people develop more than 1 primary melanoma, yet to date, no population-based prospective cohort studies have reported on risk factors for developing first vs second primary melanomas.ObjectiveTo compare the clinical characteristics of first and second melanomas and then to estimate the relative risks of developing 1 vs multiple melanomas associated with demographic, phenotypic, sun exposure, and genetic factors.Design, Setting, and ParticipantsThis population-based prospective cohort study included men and women aged 40 to 69 years recruited in 2011 and followed up until December 2018 in Queensland, Australia. Data analysis was performed from February to July 2022.ExposuresSelf-reported information about demographic, phenotypic, and sun exposure measures captured using a survey completed at baseline, and polygenic risk score for melanoma.Main Outcomes and MeasuresIncident first or second primary melanoma diagnosis, and histologic and clinical characteristics thereof. The Wei-Lin-Weissfeld model for recurrent events was used to estimate the association of each factor with the risks of first and second primary melanoma.ResultsA total of 38 845 patients (mean [SD] age at baseline, 56.1 [8.2] years; 17 775 men and 21 070 women) were included in the study. During a median follow-up period of 7.4 years, 1212 (3.1%) participants had a single primary melanoma diagnosis, and 245 (0.6%) had a second primary melanoma diagnosis. Second melanomas were more likely than first melanomas to be in situ; for invasive tumors, second melanomas were more likely to be thin (ie, ≤1 mm) than first melanomas. Having many moles at age 21 years (self-reported using visual scoring tool) was more strongly associated with second (hazard ratio [HR], 6.36; 95% CI, 3.77-10.75) than first primary melanoma (HR, 3.46; 95% CI, 2.72-4.40) (P value for difference between the HRs = .01). A high genetic predisposition (ie, polygenic risk score in tertile 3) was also more strongly associated with second (HR, 3.28; 95% CI, 2.06-5.23) than first melanoma (HR, 2.06; 95% CI, 1.71-2.49; P = .03). Second melanomas were more strongly associated with a history of multiple skin cancer excisions (HR, 2.63; 95% CI, 1.80-3.83) than first melanomas (HR, 1.86; 95% CI, 1.61-2.16; P = .05). For all other phenotypic characteristics and sun exposure measures, similarly elevated associations with first vs second melanomas were observed.Conclusions and RelevanceFindings of this cohort study suggest that within the general population, the presence of many nevi and having a high genetic predisposition to melanoma were associated with the highest risks of developing second primary melanomas.

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Section: Discussionsupporting

confidence: 89%

Risk Factors Associated With First and Second Primary Melanomas in a High-Incidence Population

et al. 2023

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“…Sarvar et al found that compared with the metachronous cohort, the synchronous cohort demonstrated significantly higher concordance between anatomical location for total lesions and lesions of the trunk. 28 The highest correlation was noted for head/neck (80%) the extremities (60%), and the back (47.5%). 28 The higher-than-expected concordance for SM suggests a “field effect” of susceptibility to malignancy of some anatomic areas.…”

Section: Discussionmentioning

confidence: 91%

“…Some studies report the highest correlation between locations of the head/neck (80%), the extremities (60%), and the back (47.5%), or no significant correlation at all. 28 …”

Section: Resultsmentioning

confidence: 99%

“… 8 Sarver et al noted that based on gender, SM had a statistically significantly higher male preponderance compared with solitary melanoma (Table 2 ). 28 …”

Section: Resultsmentioning

confidence: 99%

“…Sarver et al noted that based on gender, SM had a statistically significantly higher male preponderance. 28 (Table 2 ). We conclude that there is data linking SM with older age, male gender, and NS.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Synchronous Melanoma: Definition, Prognosis, and Implications. A Comprehensive Review of Literature

Kang,

Rajput,

Kang

2023

Plastic and Reconstructive Surgery - Global Open

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Background: Although multiple primary melanomas (MPMs) have been reported in the literature, the subgroup of synchronous melanomas (SMs) remains understudied. Methods: We conducted a comprehensive systematic review of the English literature from 1972 to 2023 to characterize SM. Our objective was to clarify the definition, determine incidence and prognosis, and present recommendations. Results: We found 18 case series articles and six case reports that met our criteria. Twelve of eighteen studies defined SM as a second primary melanoma identified within 1 month. The total number of SM patients reported was 1083. The cumulative percentage of MPM in total melanoma patients was 2.9 %, and the cumulative percentage of SM patients in MPM patients was 31.3%. SM patients trended toward higher body anatomical concordance, older age, and male sex. Despite limited data, SMs do not show a worse prognosis for patients compared with single melanomas. Conclusions: Despite a lack of consensus in the past, we recommend that SM be defined as a second primary melanoma detected within 1 month of the initial diagnosis. SMs comprise almost one-third of MPM cases and do not seem to carry any worse prognosis than the patients presenting with single melanoma. We believe older age and male sex may be more prone to SM. We recommend patient education, self-skin evaluations and TSE at initial and follow-up visits. Neither randomized controlled trials nor meta-analyses on SM exist. Ideally, further studies with a large cohort of patients are needed to accurately define SM.

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Survival and tumor characteristics of patients presenting with single primary versus second primary melanoma lesions

Cited by 2 publications

References 19 publications

Risk Factors Associated With First and Second Primary Melanomas in a High-Incidence Population

Risk Factors Associated With First and Second Primary Melanomas in a High-Incidence Population

Synchronous Melanoma: Definition, Prognosis, and Implications. A Comprehensive Review of Literature

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