title: Ten-Year Survival after Multiple Invasive Melanomas Is Worse than after a Single Melanoma: a Population-Based Study.
abstract: The prognosis of melanoma patients who are diagnosed with multiple primary lesions remains controversial. We used a large population-based cohort to re-examine this issue, applying a delayed entry methodology to avoid survival bias. Of 32,238 eligible patients diagnosed between 1995 and 2008, 29,908 (93%) had a single invasive melanoma, 2,075 (6%) had two, and 255 (1%) had three. Allowing for differences in entry time, 10-year cause-specific survival for these three groups was 89% (95% confidence interval [CI] = 88-90%), 83% (95% CI = 80-86%), and 67% (95% CI = 54-81%), respectively. After adjustment for key prognostic factors, the hazard ratio of death within 10 years from melanoma was two times higher for those with two melanomas (hazard ratio = 2.01, 95% CI = 1.57-2.59; P < 0.001) and nearly three times higher when three melanomas were diagnosed (hazard ratio = 2.91, 95% CI = 1.64-5.18; P < 0.001) compared with people with a single melanoma. Melanoma-specific mortality remained elevated after adjusting for maximum thickness or ulceration of any melanoma regardless of the index tumor. After appropriately accounting for the interval between diagnosis of the first and subsequent melanomas, patients with multiple invasive melanomas have significantly poorer survival than patients with a single invasive melanoma.
authors.affiliation: Cancer Council Queensland, Brisbane, Queensland, Australia.
authors.forename: Danny R
authors.initials: DR
authors.lastname: Youlden
authors.affiliation: Cancer Council Queensland, Brisbane, Queensland, Australia; School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia; Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia.
authors.forename: Peter D
authors.initials: PD
authors.lastname: Baade
authors.affiliation: Dermatology Research Centre, School of Medicine, Translational Research Institute, The University of Queensland, Brisbane, Queensland, Australia; Department of Dermatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
authors.forename: H Peter
authors.initials: HP
authors.lastname: Soyer
authors.affiliation: Cancer Council Queensland, Brisbane, Queensland, Australia; School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia; Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia.
authors.forename: Philippa H
authors.initials: PH
authors.lastname: Youl
authors.affiliation: Cancer Council Queensland, Brisbane, Queensland, Australia; Health Research Institute, University of the Sunshine Coast, Sunshine Coast, Queensland, Australia.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Kimlin
authors.affiliation: Cancer Council Queensland, Brisbane, Queensland, Australia; School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia.
authors.forename: Joanne F
authors.initials: JF
authors.lastname: Aitken
authors.affiliation: QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia; CRUK Manchester Institute and Institute of Inflammation and Repair, University of Manchester, Manchester, United Kingdom.
authors.forename: Adele C
authors.initials: AC
authors.lastname: Green
authors.affiliation: Department of Dermatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia; UQ Centre for Clinical Research, The University of Queensland, Brisbane, Queensland, Australia; UQ Diamantina Institute, Translational Research Institute, The University of Queensland, Brisbane, Queensland, Australia. Electronic address: k.khosrotehrani@uq.edu.au.
authors.forename: Kiarash
authors.initials: K
authors.lastname: Khosrotehrani
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006801:Humans; D008297:Male; D008545:Melanoma / Q000401:mortality* / Q000473:pathology; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011159:Population Surveillance; D011379:Prognosis; D011793:Queensland / Q000453:epidemiology; D012042:Registries; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000401:mortality* / Q000473:pathology; D015996:Survival Rate / Q000639:trends; D055815:Young Adult; D000096142:Cutaneous Malignant Melanoma