Association of multiple primary melanomas with malignancy risk: a population-based analysis of the Surveillance, Epidemiology, and End Results Program database from 1973-2014

Publication date: Available online 2 October 2018

Source: Journal of the American Academy of Dermatology

Author(s): Emily D. Cai, Susan M. Swetter, Kavita Y. Sarin

Abstract:

Background

Genetic and environmental risk factors have been associated with the development of multiple primary melanomas (MPM). We hypothesized that individuals with MPM may have increased predisposition to developing internal malignancies.

Objective

To identify the risk of subsequent malignancies in MPM patients.

Methods

Multiple primary standardized incidence ratios were analyzed for individuals with ≥1, ≥2 and ≥3 primary melanomas (PM) in the SEER database from 1973-2014.

Results

223,799 individuals with ≥1, 19,709 with ≥2 and 3,995 with ≥3 PM were identified. Risks of subsequent internal malignancy increased with number of PM, with observed to expected (O/E) ratios of 0.99, 1.14, and 1.23 (p<0.05) for patients with at least one, two and three PM respectively. Internal malignancy was higher in younger MPM patients and those with superficial spreading melanoma. The most common malignancies amongst MPM patients include breast, prostate, thyroid, soft tissue, brain, kidney, non-Hodgkin's lymphoma, and chronic lymphocytic leukemia. Risk of subsequent cutaneous melanoma increased with O/E ratios of 8.09, to 22.52, to 41.03 (p<0.05) respectively.

Limitations

SEER records limited information about pigmentation phenotypes, histology, and treatments.

Conclusion

Patients with MPM have increased risk of subsequent internal and cutaneous malignancies and may benefit from tight adherence to age-specific cancer screening.