Clinical Features and Survival of Multiple Primary Melanoma: A Belgian Single Center Cohort

Abstract

Introduction It remains unclear whether multiple primary melanoma (MPM) patients have a worse survival prognosis compared with single primary melanoma (SPM) patients. Objectives To investigate the demographics, histological features, and survival of MPM versus SPM patients. Methods Cox regression analyses compared survival between SPM and MPM patients. Furthermore, demographics and histological features of the MPM cohort were compared with the SPM patients retrieved from dermatopathology files between 2000 and 2019. Results Out of 3853 melanoma patients, 95 MPM patients were retrieved: 81 with two primary melanomas (85.2%) and 14.8% with three or more. Mean Breslow of the first melanoma was 0.84 mm [minimum (min): 0 mm, maximum (max): 16 mm, standard deviation (SD) 1.77] versus 0.37 mm (second MPM) (min: 0 mm, max: 2.5 mm, SD 0.50) and 0.33 mm (third MPM) (min: 0 mm, max: 0.6 mm, SD 0.22). The mean Breslow for the second MPM was significantly higher for men than women (0.59 mm versus 0.27 mm). First and second melanoma in MPM patients developed on preexisting melanocytic nevi in 13% and 12%, respectively. In contrast with the mean age of primary melanoma in Belgium for women (58.2 years) and men (63.3 years), MPM patients developed their first melanoma earlier, at 44.8 years and 54.6 years, respectively. The mean distribution of anatomical localization of primary and secondary melanoma was highly similar in women, whereas in men a shift towards lower extremities was observed (19% versus 28%). The thicker the primary melanoma was, the sooner the second appeared. Follow-up (2–4/year) versus (1/year) yielded a mean Breslow of 0.29 mm and 0.55 mm, respectively. Cox regression analysis with time-varying covariate revealed a tendency for a worse prognosis in 5-year survival rates, but this was not statistically significant ( p = 0.09). Patient phenotypes were not available on the histological reports. Conclusion A closer follow-up regimen of MPM versus SPM patients is probably justified.

A practical nomogram and risk stratification system predicting the cancer-specific survival for patients aged >50 with advanced melanoma

“…The above conclusions are consistent with the results in the existing studies (34)(35)(36). Currently, the effect of the number of primary melanomas on the prognosis of melanoma is still controversial (37)(38)(39)(40)(41)(42)(43).. Based on samples from SEER database 5166, this study found that patients with a single primary melanoma had a worse prognosis according to both univariate and multivariate Cox regression analyses, which is consistent with some existing studies. In addition, the nomogram was constructed utilizing a substantial sample size, resulting in a relatively comprehensive prognostic evaluation for melanoma that is not limited to a single factor.…”

Multiple Primary Melanoma Associated with CDKN2A Mutation—Case Report and Review of the Literature

“…Even though the second melanomas described in the literature had smaller Breslow indexes compared to the initial occurrences [8], our patient exhibited other histological subtypes of secondary melanomas (nodular melanoma), with elevated tumoral thickness. These findings highlighted the particular aggressive tumor's biological behavior identified in our case, despite the fact that the patient followed a rigorous specialty monitoring plan and cutaneous self-surveillance and did not encounter follow-up challenges leading to the evasion of medical surveillance due to noncompliance or relocation, as has been recorded in other cases [7].…”

“…In our report, the anatomical distribution of the melanoma lesions did not follow a specific pattern, taking into account the fact that only one tumor was located on the trunk, three were detected on the lower extremities, one on the upper extremities and the other four were identified in the head and neck area. Only one paper focusing on the North Carolina population described the cervical and cephalic areas as the most commonly affected sites [6], while the majority of studies identify the lower extremities as the most frequently involved anatomical sites in women [7].…”

Malignant features of minipig melanomas prior to spontaneous regression

“…MeLiM minipigs can develop concurrent primary melanomas at multiple sites. In humans, the outcome of patients with multiple primary cutaneous melanoma has been the subject of conflicting reports 11 – 13 . In both the original Czech MeLiM herd 14 and the French herd 15 , genetic analysis has shown that melanoma incidence and progression are caused by genetic factors with minimal environmental influence 16 .…”