title: Incidence of new primary melanomas after diagnosis of stage III and IV melanoma.
abstract: OBJECTIVE
  New primary melanomas (NPMs) have developed in some patients with metastatic melanoma treated with BRAF inhibitors. We sought to determine the background incidence of spontaneous NPMs after a diagnosis of American Joint Committee on Cancer/International Union Against Cancer stage III or IV melanoma in patients not treated with a BRAF inhibitor.
  
  
  METHODS
  Patients diagnosed with stage III or IV melanoma at Melanoma Institute Australia between 1983 and 2008 were analyzed, and those who received a BRAF inhibitor were excluded.
  
  
  RESULTS
  Two hundred twenty-nine (5%) of 4,215 patients with stage III melanoma and 43 (1%) of 3,563 patients with stage IV melanoma had at least one NPM after diagnosis of stage III or IV disease. The 6-month, 1-year, and 10-year cumulative incidence rates of developing an NPM after stage III melanoma were 1.2% (95% CI, 0.86% to 1.51%), 1.8% (95% CI, 1.44% to 2.26%), and 5.9% (95% CI, 5.08% to 6.74%), respectively. The 3-month, 6-month, and 1-year cumulative incidence rates of NPM after diagnosis of stage IV melanoma were 0.2% (95% CI, 0.07% to 0.36%), 0.3% (95% CI, 0.15% to 0.51%), and 0.4% (95% CI, 0.25% to 0.7%), respectively. In both patients with stage III and stage IV melanoma, male patients and patients with a prior history of multiple primaries had a higher incidence of NPM.
  
  
  CONCLUSIONS
  Patients with stage III and stage IV melanoma remain at risk for development of further primary melanomas, particularly if they have a history of multiple primary melanomas before stage III or IV disease. The incidence rates are lower than those reported in patients receiving BRAF inhibitors. However, the results must be compared with caution because dermatologic assessment is more frequent in BRAF inhibitor trials.
authors.affiliation: Lisa Zimmer and Dirk Schadendorf, University Hospital, University Duisburg-Essen, Essen, Germany; Lauren E. Haydu, Alexander M. Menzies, Richard A. Scolyer, Richard F. Kefford, John F. Thompson, and Georgina V. Long, Melanoma Institute Australia; Alexander M. Menzies, Richard A. Scolyer, Richard F. Kefford, and Georgina V. Long, Sydney Medical School, The University of Sydney; Richard A. Scolyer and John F. Thompson, Royal Prince Alfred Hospital; Lauren E. Haydu and John F. Thompson, The University of Sydney; John F. Thompson, Mater Hospital, Sydney; Richard F. Kefford and Georgina V. Long, Westmead Institute for Cancer Research, Westmead Hospital, Westmead, New South Wales, Australia.
authors.forename: Lisa
authors.initials: L
authors.lastname: Zimmer
authors.forename: Lauren E
authors.initials: LE
authors.lastname: Haydu
authors.forename: Alexander M
authors.initials: AM
authors.lastname: Menzies
authors.forename: Richard A
authors.initials: RA
authors.lastname: Scolyer
authors.forename: Richard F
authors.initials: RF
authors.lastname: Kefford
authors.forename: John F
authors.initials: JF
authors.lastname: Thompson
authors.forename: Dirk
authors.initials: D
authors.lastname: Schadendorf
authors.forename: Georgina V
authors.initials: GV
authors.lastname: Long
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia / Q000453:epidemiology; D002648:Child; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008545:Melanoma / Q000453:epidemiology* / Q000473:pathology; D008875:Middle Aged; D009367:Neoplasm Staging; D016609:Neoplasms, Second Primary / Q000453:epidemiology* / Q000473:pathology; D012307:Risk Factors; D012737:Sex Factors; D012878:Skin Neoplasms / Q000453:epidemiology* / Q000473:pathology; D013997:Time Factors; D055815:Young Adult