title: Risk of second primary malignancies among 1537 melanoma patients and risk of second primary melanoma among 52 354 cancer patients in Northern Italy.
abstract: BACKGROUND
  The number of melanoma survivors has been increasing for decades due to early diagnosis and improved survival. These patients have an increased risk of developing a second primary cancer (SPC); also, melanoma is frequently diagnosed among patients firstly diagnosed with an extracutaneous malignancy.
  
  
  OBJECTIVE
  We evaluated the risk of developing a SPC among 1537 melanoma patients, and the risk of second primary melanoma (SPM) in 52 354 extracutaneous cancer patients, who were treated at the European Institute of Oncology in Milan, Italy, during 2000-2010.
  
  
  METHODS
  We calculated standardized incidence ratios (SIR) by applying gender-, age-, year- and region-specific reference rates to the follow-up time accrued between the diagnosis of the first and the second primary malignancies.
  
  
  RESULTS
  Seventy-six SPC were diagnosed during a median follow-up of 4 years, of which 49 (64%) during the first 2 years upon melanoma diagnosis. The SIR was increased for cancer of breast (4.10, 95% CI 2.79-6.03), thyroid (4.67, 95% CI 1.94-11.22), brain (6.13, 95% CI 2.30-16.33) and for non-Hodgkin lymphoma (3.12, 95% CI 1.30-7.50). During a median follow-up of 4 years, 127 SPM were diagnosed: thick lesions were less frequent than for melanoma diagnosed as first cancer. The SIR was increased for cancer of breast (5.13, 95%CI 3.91-6.73), thyroid (16.2, 95%CI: 5.22-50.2), head and neck (5.62, 95%CI 1.41-22.50), soft tissue (8.68, 95%CI 2.17-34.70), cervix (12.5, 95% CI 3.14-50.20), kidney (3.19, 95%CI 1.52-6.68), prostate (4.36, 95%CI 2.63-7.24) and acute myeloid leukaemia (6.44, 95%CI 2.42-17.20).
  
  
  CONCLUSIONS
  The most likely causes of these associations are the clustering of lifestyle risk factors in the same subgroups of population, mainly on a sociocultural basis and surveillance bias. This raises important questions about how to best follow cancer survivors by avoiding an inefficient use of resources and an excessive medicalization of these patients' lives.
authors.affiliation: Unit of Cancer Risk Factors and Lifestyle Epidemiology, Institute for Cancer Research and Prevention, Florence, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Caini
authors.affiliation: Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Radice
authors.affiliation: Division of Dermatoncological Surgery, European Institute of Oncology, Milan, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Tosti
authors.affiliation: Division of Dermatoncological Surgery, European Institute of Oncology, Milan, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Spadola
authors.affiliation: Medical Oncology of Melanoma Unit, European Institute of Oncology, Milan, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Cocorocchio
authors.affiliation: Medical Oncology of Melanoma Unit, European Institute of Oncology, Milan, Italy.
authors.forename: P F
authors.initials: PF
authors.lastname: Ferrucci
authors.affiliation: Division of Dermatoncological Surgery, European Institute of Oncology, Milan, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Testori
authors.affiliation: Division of Melanoma and Muscle-Cutaneous Sarcomas, European Institute of Oncology, Milan, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Pennacchioli
authors.affiliation: Department of Dermatology, University of L'Aquila, L'Aquila, Italy.
authors.forename: M C
authors.initials: MC
authors.lastname: Fargnoli
authors.affiliation: Unit of Cancer Risk Factors and Lifestyle Epidemiology, Institute for Cancer Research and Prevention, Florence, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Palli
authors.affiliation: Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy.
authors.forename: B
authors.initials: B
authors.lastname: Bazolli
authors.affiliation: Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Botteri
authors.affiliation: Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Gandini
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008545:Melanoma / Q000453:epidemiology*; D008875:Middle Aged; D016609:Neoplasms, Second Primary / Q000453:epidemiology*; D055815:Young Adult