title: The importance of self-examination in the earliest diagnosis of multiple primary cutaneous melanomas: a report of 47 cases.
abstract: BACKGROUND
  Development of more than one primary melanoma in a patient is a relatively uncommon but well-recognized phenomenon. Its frequency has ranged from 1.2% to 8.2% in several series. This subgroup of patients with multiple primary lesions has not been characterized sufficiently. We report the experience of the Melanoma Unit of University Hospital Spedali Civili of Brescia, Italy.
  
  
  METHODS
  Study subjects were drawn from 1240 patients with histologically confirmed melanoma, including melanoma in situ. From this group, multiple melanomas developed in 47 patients (3.79%). Every one of our patients has been taught to perform self-examination of the skin to detect suspicious pigmented lesions.
  
  
  RESULTS
  Of the 47 patients described in this study, 38 had two primary melanomas, 7 had three melanomas and 2 had 5 and 10 melanomas, respectively. Mean age at first diagnosis was 46.2 years. The majority of subsequent melanomas (74.5%) were removed within 5 years of the initial operation. Synchronous lesions were found in 10 patients. In male patients, the lesion appeared most frequently on the trunk; in female patients, melanoma appeared mostly on the lower extremities. The second primary melanomas developed in the same anatomic region from the first in 53.2% of our patients. The proportion of in situ to invasive melanomas was greater for the second melanomas compared with the first melanomas. Regarding invasive melanomas, the mean thickness of the first melanomas was 1.31 mm compared with 0.66 mm for the second ones. Dividing patients into two groups, of more and less than 50, it is highlighted that in older patients synchronous lesions appear more frequently (36.4% vs. 8.0%); the median time interval between sequential melanomas is longer (84 vs. 63.7 months); and the ratio between the primary and secondary melanoma mean thickness is lower (1.21 : 1.08 vs. 1.43 : 0.63 mm).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Dermatology, University Hospital Spedali Civili, Brescia, Italy. manganoni@spedalicivili.brescia.it
authors.forename: A M
authors.initials: AM
authors.lastname: Manganoni
authors.forename: C
authors.initials: C
authors.lastname: Farisoglio
authors.forename: G
authors.initials: G
authors.lastname: Tucci
authors.forename: F
authors.initials: F
authors.lastname: Facchetti
authors.forename: P G
authors.initials: PG
authors.lastname: Calzavara Pinton
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D008545:Melanoma / Q000175:diagnosis* / Q000453:epidemiology; D008875:Middle Aged; D016609:Neoplasms, Second Primary / Q000175:diagnosis* / Q000453:epidemiology; D016353:Self-Examination; D012878:Skin Neoplasms / Q000175:diagnosis* / Q000453:epidemiology