Memorial Sloan-Kettering Cancer Center (MSKCC) researchers have found that melanoma patients with a family history of melanoma and/or dysplastic nevi (abnormal moles) are at high risk of developing multiple primary melanomas (MPM). Researchers recommend more intensive follow up for these high-risk patients.
The results of this study appearing in the Journal of the American Medical Association (JAMA), emphasize the importance of intensive dermatologic screenings for this population to identify melanoma at its earliest stage.
"Since melanoma patients with a positive family history and/or dysplastic nevi were found to be at higher risk for multiple primary melanomas, we recommend that these patients not only undergo more frequent and intensive dermatologic screening, but also practice self-exams," said Dr. Daniel Coit, co-leader of the MSKCC Melanoma Disease Management Team and senior author of the study.
The study is the first to utilize a multidisciplinary, single-institution database to identify the characteristics of patients at risk for developing MPM. Researchers prospectively followed 4484 melanoma patients treated at MSKCC. They found that:
385 patients (8.6 percent) had two or more primary melanomas, with an average of 2.3 melanomas per MPM patient;
78 percent of MPM patients had two primary melanomas with 59 percent having had a second primary melanoma detected within one year of the initial melanoma;
The estimated five-year risk of MPM is significantly higher for melanoma patients with a positive family history (18.5 percent) or dysplastic nevi (23.7 percent).
"The most striking increase we found was the likelihood that patients would develop a third primary melanoma in a relatively short period of time after they had developed a second primary melanoma," said Cristina Ferrone, MD, second year surgical fellow at MSKCC and the study's lead author. "The risk of a third primary for these patients was as high as15.6 percent after one year and over 30 percent at five years." "While second and third primary melanomas are treatable, this study shows the need for doctors and patients to be more vigilant in dermatologic screening, self-examination and in close monitoring of multiple atypical nevi," commented Alan Halpern, MD, Chief of the Dermatology Service at MSKCC and co-author of the study.
Melanoma is the most serious form of skin cancer. It is the fifth most common cancer among American men and the sixth most common among American women. In 2005, the rate of melanoma in the United States is predicted to rise by three percent to an estimated 59,580 new cases. This increasing incidence puts a greater portion of the population at risk not only for one primary melanoma but also for subsequent primary melanomas.
The study's other co-authors were Leah Ben Porat, Katherine S. Panageas, DrPH, Marianne Berwick, and Ami Patel. The melanoma database used for the study is a product of MSKCC's Melanoma Disease Management Team. This is a multidisciplinary team of surgeons, medical oncologists, dermatologists, and other medical professionals who specialize in the diagnosis and treatment of melanoma.