Survivors of Melanoma at Increase Risk of Second Cancers

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Most people are aware that having been diagnosed with skin cancer, it is important to be vigilant for additional primary skin cancers or recurrent skin cancer. A new study published in the March issue of the Archives of Dermatology survivors of melanoma skin cancer are at an increase risk of developing other non-skin cancers as well.

Portia Bardford, MD and colleagues evaluated data collected by the Surveillance, Epidemiology, and End Results (SEER) program. SEER included data from more than 89,500 patients collected from 1973 to 2000 which evaluated the risk of new malignant tumors after cutaneous malignant melanoma and other first primary cancers. There were 12,559 subsequent cancers, including 3,094 melanomas.

Melanoma is the most serious type of cancer of the skin. According to the National Cancer Institute, in 2009 there were 68,720 new cases and 8,650 deaths in the United States. When diagnosed early, survival rates are high, with a 5-year survival rate of 92.3% and 86.9% for white women and men, respectively.

The initial SEER monograph published in 2006 found that the overall risk of subsequent primary cancers, excluding nonmelanoma skin cancers, increased by 24% among melanoma survivors and that more than 20% of the new malignant tumors were also melanomas.

This latest study updates the SEER report with an additional 6 years of follow-up and an additional 23,456 survivors. Of the 89,515 patients who survived at least 2 months after their initial melanoma diagnosis, 10 857 (12.1%) developed 1 or more subsequent primary cancers.

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Survivors of a first primary melanoma were found to have an overall risk of developing a subsequent primary cancer increased by 28%. The risk was highest 2 months to 1 year after the initial melanoma diagnosis , with the risk decreasing as the latency period increased. At 20 years or longer after the initial melanoma diagnosis, however, the risk was still elevated (O:E, 5.58 [95% CI, 4.80-6.44]).

Over the span of the study, doctors diagnosed 1,156 female breast cancers, 2,200 prostate cancers and 481 non-Hodgkin's lymphomas among the more than 89,000 melanoma survivors. In each case, the number of secondary cancers reported among survivors was higher than what would have been expected in the general population.

After a second melanoma, these three (breast, prostate, and non-Hodgkin's lymphoma) were the most common new cancer diagnoses in melanoma survivors.

There is no international consensus on how melanoma survivors should be follow-up. Skin exams are recommended yearly for the first two to ten years. After that, survivors tend to be treated as the general population. This study suggest survivors should remain vigilant for life.

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Source
Increased Risk of Second Primary Cancers After a Diagnosis of Melanoma; Arch Dermatol. 2010;146(3):265-272.; Porcia T. Bradford; D. Michal Freedman; Alisa M. Goldstein; Margaret A. Tucker

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