title: Survival for patients with single and multiple primary melanomas: the genes, environment, and melanoma study.
abstract: OBJECTIVE
  Little is known about survival after a diagnosis of a second or higher-order (multiple) primary melanoma, and no study has explored survival in a population-based sample that included patients with single primary melanomas (SPMs) and multiple primary melanomas (MPMs) of any stage. Because people with a first primary melanoma are known to have an increased risk of being diagnosed with another, evidence for prognosis is needed.
  
  
  OBJECTIVE
  To determine whether survival after diagnosis was better in patients with MPMs than with SPMs, as suggested in a recent study. DESIGN Survival analysis with median follow-up of 7.6 (range, 0.4-10.6) years.
  
  
  METHODS
  The Genes, Environment, and Melanoma Study enrolled incident cases of melanoma from population-based cancer registries in Australia, Canada, Italy, and the United States. Multiple primary melanomas were ascertained during a longer period than SPM.
  
  
  METHODS
  Two thousand three hundred seventy-two patients with SPM and 1206 with MPM.
  
  
  METHODS
  Diagnosis with melanoma.
  
  
  METHODS
  Melanoma-specific fatality hazard ratios (HR) and 95% confidence intervals associated with clinical and pathological characteristics of SPM, MPM, and both in Cox proportional hazards regression models.
  
  
  RESULTS
  Melanoma thickness was the main determinant of fatality (HR for >4 mm, 7.68 [95% CI, 4.46-13.23]); other independent predictors were ulceration, mitoses, and scalp location. After adjustment for these other predictors, we found little difference in fatality between MPM and SPM (HR for MPM relative to SPM, 1.24 [95% CI, 0.91-1.69; P = .18]). Thicker SPM, however, had higher fatality (HR for >4 mm, 13.56 [95% CI, 6.47-28.40]) than thicker MPM (2.93 [1.17-7.30]).
  
  
  CONCLUSIONS
  Although overall fatalities due to SPM and MPM were similar, relative fatality for thicker SPM was greater than that for thicker MPM. This finding may offer support for a difference in outcome between patients with SPM and MPM related to factors other than closer surveillance and earlier diagnosis. The better outcomes are worth further exploration.
authors.affiliation: Cancer Epidemiology and Services Research, Sydney School of Public Health, University of Sydney, Sydney, Australia.
authors.forename: Anne
authors.initials: A
authors.lastname: Kricker
authors.forename: Bruce K
authors.initials: BK
authors.lastname: Armstrong
authors.forename: Chris
authors.initials: C
authors.lastname: Goumas
authors.forename: Nancy E
authors.initials: NE
authors.lastname: Thomas
authors.forename: Lynn
authors.initials: L
authors.lastname: From
authors.forename: Klaus
authors.initials: K
authors.lastname: Busam
authors.forename: Peter A
authors.initials: PA
authors.lastname: Kanetsky
authors.forename: Richard P
authors.initials: RP
authors.lastname: Gallagher
authors.forename: Loraine D
authors.initials: LD
authors.lastname: Marrett
authors.forename: Pamela A
authors.initials: PA
authors.lastname: Groben
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Gruber
authors.forename: Hoda
authors.initials: H
authors.lastname: Anton-Culver
authors.forename: Stefano
authors.initials: S
authors.lastname: Rosso
authors.forename: Terence
authors.initials: T
authors.lastname: Dwyer
authors.forename: Marianne
authors.initials: M
authors.lastname: Berwick
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008545:Melanoma / Q000473:pathology*; D008875:Middle Aged; D009367:Neoplasm Staging; D009378:Neoplasms, Multiple Primary / Q000473:pathology*; D011379:Prognosis; D016016:Proportional Hazards Models; D012042:Registries; D012878:Skin Neoplasms / Q000473:pathology*; D016019:Survival Analysis; D015996:Survival Rate; D055815:Young Adult