Multiple primary melanomas: Implications for screening and follow-up programs for melanoma

Abstract

Once individuals are diagnosed with melanoma, they are in a high-risk population for having other primary site melanomas diagnosed and should be placed in an intensive follow-up protocol consisting of a complete skin examination.

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.…”

“…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. Two hypotheses have been proposed to explain why subsequent melanomas in patients with MPM are thinner: 1) close surveillance of patients who had a previous melanoma, leading to the early detection of any additional melanomas 15,21,22 ; and 2) distinct tumor biology in MPM versus SPM, because melanomas in patients with MPM have less aggressive tumor biology than melanomas in patients with SPM. 12 The hypothesis that close surveillance of patients with melanoma may lead to thinner melanomas is supported by a recent retrospective study, which indicated that patients with MPM who received regular follow-up had thinner melanomas than those who were not followed regularly.…”

“…22 The importance of receiving follow-up skin examinations was highlighted by Brobeil et al, who demonstrated that 93% (41 of 44) of second primary melanomas in patients with MPM over an 8-year period were observed by a physician. 15 Lower extremities Studies examining the second hypothesis of distinct tumor biology in MPM and SPM are lacking. Some investigators have observed a better prognosis in patients who have MPM compared with patients who have SPM.…”

“…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).…”

Malignant Melanoma S3‐Guideline “Diagnosis, Therapy and Follow‐up of Melanoma”

“…Depending on tumor thickness, the majority of recurrences even in thin melanomas (< 1.0 mm), occurred within the first years after primary diagnosis [590,596,599]. The risk for recurrence after 10 years is roughly 1 % [588].…”