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Clinicopathological Features of and Risk Factors for Multiple Primary Melanomas
Cristina R. Ferrone, MD;
Leah Ben Porat;
Katherine S. Panageas, DrPH;
Marianne Berwick;
Allan C. Halpern, MD;
Ami Patel;
Daniel G. Coit, MD
JAMA. 2005;294:1647-1654.
Context The incidence of multiple primary melanomas ranges from 1.3% to 8.0% in large retrospective reviews; however, the impact of certain risk factors is not understood.
Objectives To determine the incidence of multiple primary melanomas (MPM) from a prospective, single-institution, multidisciplinary database, and to describe the clinical and pathological characteristics and risk factors specific to these patients.
Design and Setting Review of a prospectively maintained database at Memorial Sloan-Kettering Cancer Center in New York, NY.
Patients A total of 4484 patients diagnosed with a first primary melanoma between January 1, 1996, and December 31, 2002.
Main Outcome Measures Incidence of and risk factors for MPM.
Results Three hundred eighty-five patients (8.6%) had 2 or more primary melanomas, with an average of 2.3 melanomas per MPM patient. Seventy-eight percent had 2 primary melanomas. For 74% of patients, the initial melanoma was the thickest tumor. Fifty-nine percent presented with their second primary tumor within 1 year. Twenty-one percent of MPM patients had a positive family history of melanoma compared with only 12% of patients with a single primary melanoma (SPM) (P<.001). Thirty-eight percent of MPM patients had dysplastic nevi compared with 18% of SPM patients (P<.001). The estimated cumulative 5-year risk of a second primary tumor for the entire cohort was 11.4%, with almost half of that risk occurring within the first year. For patients with a positive family history or dysplastic nevi, the estimated 5-year risk of MPM was significantly higher at 19.1% and 23.7%, respectively. The most striking increase in incidence for the MPM population was seen for development of a third primary melanoma from the time of second primary melanoma, which was 15.6% at 1 year and 30.9% at 5 years.
Conclusions The incidence of MPM is increased in patients with a positive family history and/or dysplastic nevi. These patients should undergo intensive dermatologic screening and should consider genetic testing.
Author Affiliations: Departments of Surgery (Drs Ferrone and Coit and Ms Patel), Epidemiology and Biostatistics (Mss Porat and Berwick and Dr Panageas), and Dermatology (Dr Halpern), Memorial Sloan-Kettering Cancer Center, New York, NY.
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