title: Melanoma as a subsequent neoplasm in adult survivors of childhood cancer: a report from the childhood cancer survivor study.
abstract: BACKGROUND
  Childhood cancer survivors have a sixfold increased risk of developing subsequent neoplasms when compared to the general population. We sought to describe the occurrence of melanoma as a subsequent neoplasm among adult survivors of childhood cancer.
  
  
  METHODS
  Among 14,358 5-year survivors of childhood cancer diagnosed between 1970 and 1986, we calculated the cumulative incidence, standardized incidence ratio (SIR), and absolute excess risk (AER) of subsequent melanoma. Potential risk factors were assessed using a cause-specific hazards model.
  
  
  RESULTS
  Fifty-seven melanomas (46 invasive, 2 ocular, and 9 in situ) occurred in 51 survivors. The median time to the development of melanoma was 21.0 years (range: 5.6-35.4 years) and the median age at melanoma was 32.3 years (range: 10.9-49.0 years). Initial cancer diagnoses included soft tissue and bone sarcoma (n = 15), leukemia (13), lymphoma (14), central nervous system malignancy (5), Wilms tumor (3), and neuroblastoma (1). The cumulative incidence of first subsequent melanoma at 35 years from initial cancer diagnosis was 0.55% [95% confidence interval (CI): 0.37-0.73]. The SIR of subsequent invasive malignant melanoma of the skin was 2.42 (95% CI: 1.77-3.23), and the AER was 0.10 (95% CI: 0.05-0.15) per 1,000 person-years. No statistically significant associations were found between melanoma risk and family history of cancer, demographic, or treatment-related factors.
  
  
  CONCLUSIONS
  Survivors of childhood cancer have an approximate 2.5-fold increased risk of melanoma. Early screening and prevention strategies are warranted.
authors.affiliation: Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA. alberto.pappo@stjude.org
authors.forename: A S
authors.initials: AS
authors.lastname: Pappo
authors.forename: G T
authors.initials: GT
authors.lastname: Armstrong
authors.forename: W
authors.initials: W
authors.lastname: Liu
authors.forename: D K
authors.initials: DK
authors.lastname: Srivastava
authors.forename: A
authors.initials: A
authors.lastname: McDonald
authors.forename: W M
authors.initials: WM
authors.lastname: Leisenring
authors.forename: S
authors.initials: S
authors.lastname: Hammond
authors.forename: M
authors.initials: M
authors.lastname: Stovall
authors.forename: J P
authors.initials: JP
authors.lastname: Neglia
authors.forename: L L
authors.initials: LL
authors.lastname: Robison
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008545:Melanoma / Q000453:epidemiology*; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*; D016609:Neoplasms, Second Primary / Q000453:epidemiology*; D017741:Survivors / Q000706:statistics & numerical data*; D055815:Young Adult