Survival in patients with multiple primary melanomas: Systematic review and meta-analysis

Abstract

Background:The literature surrounding survival of patients with multiple primary melanomas (MPM) yields variable and opposing findings, constrained by statistical challenges.Objectives: To critically examine the available literature regarding survival of patients with MPM compared with single primary melanomas (SPM) and detail statistical methods employed.Methods: Electronic searches of Pubmed, Embase, Web of Science and Scopus, with crosschecking of references, for the period January 1956 -June 2019 were carried out. All studies published in English examining survival in patients with multiple melanoma were included. Case studies and small case series were excluded.Results: Fourteen studies were eligible for inclusion. Conclusions on survival varied markedly depending on the statistical method used. Four studies that accounted for survival bias by partitioning the survival time were included in the quantitative review, with three of these reporting a survival disadvantage for MPM, while the fourth showed no difference in survival. Pooled HR was 1.39 (1.07-1.81) but with significant heterogeneity (I 2 = 96.8% P het < 0.001).Limitations: Studies showed significant heterogeneity in methodology. Conclusions:When data was analysed with robust statistical methods, patients with MPM had a survival disadvantage compared with patients with SPM. Capsule Summary-Literature regarding survival of patients with multiple primary melanoma (MPM) compared with single primary melanoma (SPM) is varied according to the method of calculation of the survival interval.-Studies employing delayed-entry or time-varying statistical analyses address survival bias.A meta-analysis of such studies demonstrates survival disadvantage of MPM.

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

“…Another study used delayed-entry methods and also found a worse survival for MPM patients [ 29 ]. Finally, it has also been suggested that including in situ melanomas in the survival studies does not influence the survival of MPM patients, and that it might dilute the opportunity to detect a real effect [ 31 ].…”

Crosstalk of the Wnt/β-Catenin Signaling Pathway in the Induction of Apoptosis on Cancer Cells

“…In 2016, 82,476 new melanoma cases were reported in the USA, while about 7200 deaths due to melanoma were reported in 2019 [ 185 ]. Patients diagnosed with primary melanoma have a 5-fold higher risk of developing invasive melanoma with respect to the general population [ 186 ]. The early signs of melanoma include asymmetric lesions with irregular edges, a mottled color, ≥6 mm in diameter, and/or the rapid development of a new lesion, particularly in adults.…”