Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 3/2012

01-03-2012 | Melanomas

Clinicopathologic Features of Incident and Subsequent Tumors in Patients with Multiple Primary Cutaneous Melanomas

Authors: Rajmohan Murali, MBBS, MD, FRCPA, Chris Goumas, MPH, Anne Kricker, PhD, Lynn From, MD, FRCPC, Klaus J. Busam, MD, Colin B. Begg, PhD, Terence Dwyer, MD, MPH, Stephen B. Gruber, MD, PhD, MPH, Peter A. Kanetsky, PhD, MPH, Irene Orlow, PhD, Stefano Rosso, PhD, Nancy E. Thomas, MD, PhD, Marianne Berwick, PhD, MPH, Richard A. Scolyer, MBBS, MD, FRCPA, FRCPath, Bruce K. Armstrong, AM, DPhil, FRACP, FAFPHM, FAA, For the GEM Study Group

Published in: Annals of Surgical Oncology | Issue 3/2012

Login to get access

Abstract

Background

0.6–12.7% of patients with primary cutaneous melanoma will develop additional melanomas. Pathologic features of tumors in patients with multiple primary cutaneous melanomas have not been well described. In this large, international, multicenter, case–control study, we compared the clinicopathologic features of a subsequent melanoma with the preceding (usually the first) melanoma in patients with multiple primary cutaneous melanomas, and with those of melanomas in patients with single primary cutaneous melanomas.

Methods

Multiple primary melanoma (cases) and single primary invasive melanoma (controls) patients from the Genes, Environment and Melanoma (GEM) study were included if their tumors were available for pathologic review and confirmed as melanoma. Clinicopathologic characteristics of invasive subsequent and first melanomas in cases and invasive single melanomas in controls were compared.

Results

A total of 473 pairs comprising a subsequent and a first melanoma and 1,989 single melanomas were reviewed. Forward stepwise regression modeling in 395 pairs with complete data showed that, compared with first melanomas, subsequent melanomas were more commonly contiguous with a dysplastic nevus, more prevalent on the head/neck and legs than other sites, and thinner. Compared with single primary melanomas, subsequent melanomas were more likely to be associated with a contiguous dysplastic nevus, more prevalent on the head/neck and legs, and thinner. The same differences were observed when subsequent melanomas were compared with single melanomas. First melanomas were more likely than single melanomas to have associated solar elastosis and no observed mitoses.

Conclusions

Thinner subsequent than first melanomas suggest earlier diagnosis, perhaps due to closer clinical scrutiny. The association of subsequent melanomas with dysplastic nevi is consistent with the latter being risk factors or risk markers for melanoma.
Appendix
Available only for authorised users
Literature
1.
Savoia P, Quaglino P, Verrone A, et al. Multiple primary melanomas: analysis of 49 cases. Melanoma Res. 1998;8(4):361–6.PubMedCrossRef
2.
Ferrone CR, Ben Porat L, Panageas KS, et al. Clinicopathological features of and risk factors for multiple primary melanomas. JAMA. 2005;294(13):1647–54.PubMedCrossRef
3.
Uliasz A, Lebwohl M. Patient education and regular surveillance results in earlier diagnosis of second primary melanoma. Int J Dermatol. 2007;46(6):575–7.PubMedCrossRef
4.
Burden AD, Newell J, Andrew N, et al. Genetic and environmental influences in the development of multiple primary melanoma. Arch Dermatol. 1999;135(3):261–5.PubMedCrossRef
5.
Burden AD, Vestey JP, Sirel JM, et al. Multiple primary melanoma: risk factors and prognostic implications. BMJ. 1994;309(6951):375.PubMedCrossRef
6.
Lucchina LC, Barnhill RL, Duke DM, et al. Familial cutaneous melanoma. Melanoma Res. 1995;5(6):413–8.PubMedCrossRef
7.
Gupta BK, Piedmonte MR, Karakousis CP. Attributes and survival patterns of multiple primary cutaneous malignant melanoma. Cancer. 1991;67(7):1984–9.PubMedCrossRef
8.
Moseley HS, Giuliano AE, Storm FK, 3rd, et al. Multiple primary melanoma. Cancer. 1979;43(3):939–44.PubMedCrossRef
9.
Slingluff CL Jr, Vollmer RT, Seigler HF. Multiple primary melanoma: incidence and risk factors in 283 patients. Surgery. 1993;113(3):330–9.PubMed
10.
Kang S, Barnhill RL, Mihm MC, Jr., et al. Multiple primary cutaneous melanomas. Cancer. 1992;70(7):1911–6.PubMedCrossRef
11.
Reimer RR, Clark WH Jr, Greene MH, et al. Precursor lesions in familial melanoma. A new genetic preneoplastic syndrome. JAMA. 1978;239(8):744–6.PubMedCrossRef
12.
Frank W, Rogers GS. Melanoma update. Second primary melanoma. J Dermatol Surg Oncol. 1993;19(5):427–30.PubMed
13.
14.
15.
Cascinelli N, Fontana V, Cataldo I, et al. Multiple primary melanoma. Tumori. 1975;61(5):481–6.PubMed
16.
Scheibner A, Milton GW, McCarthy WH, et al. Multiple primary melanoma—a review of 90 cases. Australas J Dermatol. 1982;23(1):1–8.PubMedCrossRef
17.
Titus-Ernstoff L, Duray PH, Ernstoff MS, et al. Dysplastic nevi in association with multiple primary melanoma. Cancer Res. 1988;48(4):1016–8.PubMed
18.
Ariyan S, Poo WJ, Bolognia J, et al. Multiple primary melanomas: data and significance. Plast Reconstr Surg. 1995;96(6):1384–9.PubMedCrossRef
19.
Giles G, Staples M, McCredie M, et al. Multiple primary melanomas: an analysis of cancer registry data from Victoria and New South Wales. Melanoma Res. 1995;5(6):433–8.PubMedCrossRef
20.
Marghoob AA, Slade J, Kopf AW, et al. Risk of developing multiple primary cutaneous melanomas in patients with the classic atypical-mole syndrome: a case-control study. Br J Dermatol. 1996;135(5):704–11.PubMedCrossRef
21.
Brobeil A, Rapaport D, Wells K, et al. Multiple primary melanomas: implications for screening and follow-up programs for melanoma. Ann Surg Oncol. 1997;4(1):19–23.PubMedCrossRef
22.
Johnson TM, Hamilton T, Lowe L. Multiple primary melanomas. J Am Acad Dermatol. 1998;39(3):422–7.PubMedCrossRef
23.
Monzon J, Liu L, Brill H, et al. CDKN2A mutations in multiple primary melanomas. N Engl J Med. 1998;338(13):879–87.PubMedCrossRef
24.
Bhatia S, Estrada-Batres L, Maryon T, et al. Second primary tumors in patients with cutaneous malignant melanoma. Cancer. 1999;86(10):2014–20.PubMedCrossRef
25.
DiFronzo LA, Wanek LA, Elashoff R, et al. Increased incidence of second primary melanoma in patients with a previous cutaneous melanoma. Ann Surg Oncol. 1999;6(7):705–11.PubMedCrossRef
26.
Wolff J, Wollina U. Second malignancies in melanoma patients in Thuringia. J Eur Acad Dermatol Venereol. 2000;14(6):479–83.PubMedCrossRef
27.
DiFronzo LA, Wanek LA, Morton DL. Earlier diagnosis of second primary melanoma confirms the benefits of patient education and routine postoperative follow-up. Cancer. 2001;91(8):1520–4.PubMedCrossRef
28.
Schmid-Wendtner MH, Baumert J, Wendtner CM, et al. Risk of second primary malignancies in patients with cutaneous melanoma. Br J Dermatol. 2001;145(6):981–5.PubMedCrossRef
29.
Stam-Posthuma JJ, van Duinen C, Scheffer E, et al. Multiple primary melanomas. J Am Acad Dermatol. 2001;44(1):22–7.PubMedCrossRef
30.
Blackwood MA, Holmes R, Synnestvedt M, et al. Multiple primary melanoma revisited. Cancer. 2002;94(8):2248–55.PubMedCrossRef
31.
Doubrovsky A, Menzies SW. Enhanced survival in patients with multiple primary melanoma. Arch Dermatol. 2003;139(8):1013–8.PubMedCrossRef
32.
Goggins WB, Tsao H. A population-based analysis of risk factors for a second primary cutaneous melanoma among melanoma survivors. Cancer. 2003;97(3):639–43.PubMedCrossRef
33.
Titus-Ernstoff L, Perry AE, Spencer SK, et al. Multiple primary melanoma: two-year results from a population-based study. Arch Dermatol. 2006;142(4):433–8.PubMedCrossRef
34.
Bower MR, Scoggins CR, Martin RC 2nd, et al. Second primary melanomas: incidence and outcome. American Surgeon. 2010;76(7):675–81.PubMed
35.
Begg CB, Hummer AJ, Mujumdar U, et al. A design for cancer case-control studies using only incident cases: experience with the GEM study of melanoma. Int J Epidemiol. 2006;35(3):756–64.PubMedCrossRef
36.
Barros AJ, Hirakata VN. Alternatives for logistic regression in cross-sectional studies: an empirical comparison of models that directly estimate the prevalence ratio. BMC Med Res Methodol. 2003;3:21.PubMedCrossRef
37.
Guerriere-Kovach PM, Hunt EL, Patterson JW, et al. Primary melanoma of the skin and cutaneous melanomatous metastases: comparative histologic features and immunophenotypes. Am J Clin Pathol. 2004;122(1):70–7.PubMedCrossRef
38.
Orlow I, Tommasi DV, Bloom B, et al. Evaluation of the clonal origin of multiple primary melanomas using molecular profiling. J Invest Dermatol. 2009;129(8):1972–82.PubMedCrossRef
39.
Manganoni AM, Farisoglio C, Tucci G, et al. The importance of self-examination in the earliest diagnosis of multiple primary cutaneous melanomas: a report of 47 cases. J Eur Acad Dermatol Venereol. 2007;21(10):1333–6.PubMedCrossRef
40.
Allen AC, Spitz S. Malignant melanoma: a clinicopathological analysis of the criteria for diagnosis and prognosis. Cancer. 1953;6(1):1–45.PubMedCrossRef
41.
Rigel DS, Friedman RJ, Kopf AW, et al. Importance of complete cutaneous examination for the detection of malignant melanoma. J Am Acad Dermatol. 1986;14(5 Pt 1):857–60.PubMedCrossRef
42.
Carli P, De Giorgi V, Chiarugi A, et al. Multiple synchronous cutaneous melanomas: implications for prevention. Int J Dermatol. 2002;41(9):583–5.PubMedCrossRef
43.
Poo-Hwu WJ, Ariyan S, Lamb L, et al. Follow-up recommendations for patients with American Joint Committee on Cancer Stages I-III malignant melanoma. Cancer. 1999;86(11):2252–8.PubMedCrossRef
44.
Green A, MacLennan R, Youl P, et al. Site distribution of cutaneous melanoma in Queensland. Int J Cancer. 1993;53(2):232–6.PubMedCrossRef
45.
Whiteman DC, Bray CA, Siskind V, et al. A comparison of the anatomic distribution of cutaneous melanoma in two populations with different levels of sunlight: the west of Scotland and Queensland, Australia 1982–2001. Cancer Causes Control. 2007;18(5):485–91.PubMedCrossRef
46.
Kricker A, Armstrong BK, Goumas C, et al. Ambient UV, personal sun exposure and risk of multiple primary melanomas. Cancer Causes Control. 2007;18(3):295–304.PubMedCrossRef
47.
Duncan LM. The classification of cutaneous melanoma. Hematol Oncol Clin North Am. 2009;23(3):501–13, ix.
48.
Balch CM, Wilkerson JA, Murad TM, et al. The prognostic significance of ulceration of cutaneous melanoma. Cancer. 1980;45(12):3012–7.PubMedCrossRef
49.
Lock-Andersen J, Hou-Jensen K, Hansen JP, et al. Observer variation in histological classification of cutaneous malignant melanoma. Scand J Plast Reconstr Surg Hand Surg. 1995;29(2):141–8.PubMedCrossRef
50.
Corona R, Mele A, Amini M, et al. Interobserver variability on the histopathologic diagnosis of cutaneous melanoma and other pigmented skin lesions. J Clin Oncol. 1996;14(4):1218–23.PubMed
51.
Crutcher WA, Sagebiel RW. Prevalence of dysplastic naevi in a community practice. Lancet. 1984;1(8379):729.PubMedCrossRef
52.
Greene MH, Clark WH Jr, Tucker MA, et al. High risk of malignant melanoma in melanoma-prone families with dysplastic nevi. Ann Intern Med. 1985;102(4):458–65.PubMed
53.
Tucker MA, Fraser MC, Goldstein AM, et al. Risk of melanoma and other cancers in melanoma-prone families. J Invest Dermatol. 1993;100(3):350S–5S.PubMedCrossRef
54.
Carey WP, Jr., Thompson CJ, Synnestvedt M, et al. Dysplastic nevi as a melanoma risk factor in patients with familial melanoma. Cancer. 1994;74(12):3118–25.PubMedCrossRef
Metadata
Title
Clinicopathologic Features of Incident and Subsequent Tumors in Patients with Multiple Primary Cutaneous Melanomas
Authors
Rajmohan Murali, MBBS, MD, FRCPA
Chris Goumas, MPH
Anne Kricker, PhD
Lynn From, MD, FRCPC
Klaus J. Busam, MD
Colin B. Begg, PhD
Terence Dwyer, MD, MPH
Stephen B. Gruber, MD, PhD, MPH
Peter A. Kanetsky, PhD, MPH
Irene Orlow, PhD
Stefano Rosso, PhD
Nancy E. Thomas, MD, PhD
Marianne Berwick, PhD, MPH
Richard A. Scolyer, MBBS, MD, FRCPA, FRCPath
Bruce K. Armstrong, AM, DPhil, FRACP, FAFPHM, FAA
For the GEM Study Group
Publication date
01-03-2012
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 3/2012
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-011-2058-8

Other articles of this Issue 3/2012

Annals of Surgical Oncology 3/2012 Go to the issue

Gastrointestinal Oncology

Precise Pathologic Examination Decreases the False-Negative Rate of Sentinel Lymph Node Biopsy in Gastric Cancer

Healthcare Policy and Outcomes

Can the Beast Be Tamed? The Woeful Tale of Accurate Health Information on the Internet

Thoracic Oncology

Expression Analysis Elucidates the Roles of MAML1 and Twist1 in Esophageal Squamous Cell Carcinoma Aggressiveness and Metastasis

Bone and Soft Tissue Sarcomas

Malignant Peripheral Nerve Sheath Tumors (MPNST): The Mayo Clinic Experience

Colorectal Cancer

Anterior-entry Abdominoperineal Resection: A Variation in the Method of Perineal Dissection

Head and Neck Oncology

Salvage Treatment for Isolated Regional Failure of Nasopharyngeal Carcinoma after Primary Radiotherapy