The importance of self‐examination in the earliest diagnosis of multiple primary cutaneous melanomas: a report of 47 cases

Abstract

The study confirms that second primary melanoma is usually thinner than the first lesion, and it is more common in the same region of the body as the initial melanoma. The highest risk for a second melanoma is during the first 5 years, but a much longer time interval of 28 years is possible. Continued medical follow-up with complete skin examinations seems prudent, but it is very important to promote self-skin evaluation in patients to detect not only metastases but also subsequent primary melanomas in their earliest phases.

Clinicopathologic Features of Incident and Subsequent Tumors in Patients with Multiple Primary Cutaneous Melanomas

“…While a significant correlation between their sites has not been reported in most studies, 8, 10, 14, 16, 20, 22, 40 several studies 19, 34, 39 did find site concordance ranging between 52% and 56%. Some degree of site concordance between melanomas in the same patient would be expected because the same patterns of sun exposure and sun protection underlie the occurrence of both lesions.…”

“…8, 27 Studies that included in situ melanomas reported that a greater proportion of subsequent melanomas were in situ. 2, 3, 20, 21, 29, 39 Although melanomas that were exclusively in situ were excluded from the present analysis, invasive subsequent melanomas were more commonly associated with an in situ component (92%) than preceding melanomas (89%) and single melanomas (88%). The high prevalence of an associated in situ component supports the proposition that the subsequent melanomas in patients with multiple melanomas in this study were primary at the site of diagnosis.…”

“…The comparatively weak site concordance and the fact that subsequent melanomas are diagnosed synchronously (within three months) with the first melanoma in up to 60% of patients with multiple melanomas (27% of the 395 pairs in the present study – results not shown) 21 highlight the need for careful and complete skin examination when assessing patients with melanoma. 39, 41, 42 Moreover, the increased risk of metachronous melanomas, the long intervals (>20 years 1 ) within which they may be diagnosed, and the probable benefits of early diagnosis of additional melanomas and metastatic disease suggest that patients with one melanoma may benefit from regular follow up. 27, 43 This suggestion is strengthened by our findings that subsequent melanomas diagnosed ≥ 3 years after a first, when perhaps clinical follow-up has become less intense or ceased, were thicker, more likely to be of nodular type and to have mitoses, than subsequent melanomas diagnosed within 3 years of the first.…”

Clinical and prognostic reports from 270 patients with multiple primary melanomas: a 34‐year single‐institution study

“…Development of multiple primaries is not uncommon in patients affected by melanoma, with an estimated incidence ranging from 1.3% to 8.5% in several series 4–10 . In our database, collecting all melanoma patients diagnosed and followed up at our institution during a 34‐year period and comprising nearly five thousand records, at present the percentage of MPM patients is assessed around 6.4%.…”

“…Development of more than one primary melanoma in a sole patient is a well‐recognized phenomenon, first described by Pack et al. 2 in 1952 and could be related to a specific genetics background or to a family history for melanoma 3,4 . Its frequency ranges from 1.2% to 8.2% in the most recent published series 4–10 .…”