Increased risk of second primary cancers after a diagnosis of melanoma.
OBJECTIVE
To quantify the risk of subsequent primary cancers among patients with primary cutaneous malignant melanoma.


METHODS
Population-based registry study.


METHODS
We evaluated data from 9 cancer registries of the Surveillance, Epidemiology, and End Results program from 1973-2006.


METHODS
We included 89 515 patients who survived at least 2 months after their initial melanoma diagnosis.


RESULTS
Of the patients with melanoma, 10 857 (12.1%) developed 1 or more subsequent primary cancers. The overall risk of a subsequent primary cancer increased by 28% (observed to expected [O:E] ratio = 1.28). One quarter of the cancers were subsequent primary melanomas (O:E = 8.61). Women with head and neck melanoma and patients younger than 30 had markedly increased risks (O:E = 13.22 and 13.40, respectively) of developing a subsequent melanoma. Second melanomas were more likely to be thin than were the first of multiple primary melanomas (thickness at diagnosis <1.00 mm, 77.9% vs 70.3%, respectively; P < .001). Melanoma survivors had increased risk of developing several cancers; the most common cancers with elevated risks were breast, prostate, and non-Hodgkin lymphoma (O:E = 1.10, 1.15, and 1.25, respectively).


CONCLUSIONS
Melanoma survivors have an approximately 9-fold increased risk of developing subsequent melanoma compared with the general population. The risk remains elevated more than 20 years after the initial melanoma diagnosis. This increased risk may be owing to behavioral factors, genetic susceptibility, or medical surveillance. Although the percentage of subsequent primary melanomas thicker than 1 mm is lower than for the first of multiple primary melanomas, it is still substantial. Melanoma survivors should remain under surveillance not only for recurrence but also for future primary melanomas and other cancers.
Genetic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, 6120 Executive Boulevard, Rockville, MD 20852, USA. bradfordp@mail.nih.gov
Porcia T
PT
Bradford
D Michal
DM
Freedman
Alisa M
AM
Goldstein
Margaret A
MA
Tucker
D000328:Adult; D001943:Breast Neoplasms / Q000453:epidemiology / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D015994:Incidence; D008228:Lymphoma, Non-Hodgkin / Q000453:epidemiology / Q000209:etiology; D008297:Male; D008545:Melanoma / Q000175:diagnosis*; D008875:Middle Aged; D016609:Neoplasms, Second Primary / Q000453:epidemiology / Q000209:etiology*; D011159:Population Surveillance / Q000379:methods*; D011471:Prostatic Neoplasms / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D018426:SEER Program; D012878:Skin Neoplasms / Q000175:diagnosis*; D013997:Time Factors; D014481:United States / Q000453:epidemiology