Un melanoma, cuidado con el segundo

Journal Scan / Research · November 09, 2019

Risk of Second Primary Cutaneous and Non-Cutaneous Melanoma Following Cutaneous Melanoma Diagnosis

Journal of the American Academy of Dermatology

TAKE-HOME MESSAGE

• This retrospective analysis of the SEER database found that patients with prior cutaneous melanoma (N=169,841) had greater odds of developing a second primary cutaneous melanoma (standardized incidence ratio[SIR], 8.17), ocular melanoma (SIR, 1.99), oral melanoma (SIR, 6.87), and vaginal/exocervical melanoma (SIR, 10.17) than the general population.

• These findings suggest that, in addition to monitoring for second primary cutaneous melanomas, physicians should monitor patients with a history of a primary cutaneous melanoma for non-cutaneous melanomas.

– InYoung Kim, MD, PhD

Dermatology

Written by

 

 

Michael E Ming MD, MSCE

The authors used SEER, the national database, to study whether patients with cutaneous melanoma had a higher-than-expected rate of subsequent melanomas, looking at both additional primary cutaneous melanoma as well as new diagnoses of ocular, oral, or vaginal/exocervical melanoma. Almost 170,000 patients with cutaneous melanoma were included in their study. The authors found a higher-than-expected risk of developing both cutaneous and non-cutaneous melanoma, but the actual number of patients who developed non-cutaneous melanomas was very small. Of the 170,000 patients, 9989 (5.9%) had an additional cutaneous melanoma, 67 (0.04%) had ocular melanoma, 5 (0.003%) had oral melanoma, and 9 (0.01% of the women in the study) had vaginal melanoma. Although the risks for ocular/oral/vaginal melanoma were higher than for the baseline population, those melanomas are very rare and the absolute increased risk was very low. The authors calculated that there would be one additional ocular melanoma beyond that expected in the baseline population for every 52,630 cutaneous melanoma patients.

The study design makes it difficult to be confident that the additional reported melanomas are actually new primary melanomas rather than metastases from cutaneous melanomas. Although it sounds like it would be unusual, I have personally seen several patients who have had melanoma metastasize to the eye. Also, the study design does not allow us to know whether the patients who had additional melanomas had a known genetic syndrome that would put them at increased risk. That being said, my own anecdotal experience is similar to the authors' findings. I have seen many thousands of melanoma patients personally over the past 19 years. Second primary melanomas are common for those patients, but non-cutaneous primary melanomas are not. I have seen 1 patient over those 19 years who has had both primary ocular melanoma and primary cutaneous melanoma. I have never seen a patient with both primary oral melanoma and primary cutaneous melanoma, nor have I seen a patient with both primary vaginal melanoma and primary cutaneous melanoma.

I stress to my melanoma patients that they are at increased risk of an additional primary cutaneous melanoma. I discuss at each visit that they need to protect their skin from ultraviolet light damage, and that they need to familiarize themselves with their own skin so that they will find early changes that may signal a new cutaneous melanoma. However, I do not stress to them the risk of ocular, oral, or vaginal melanoma.

Abstract

BACKGROUND

While cutaneous melanomas (CM) account for greater than 90% of all melanomas, non-cutaneous melanomas (NCM) are more aggressive and associated with worse outcomes. The shared progenitor cell type among CM and NCM suggests that patients with a history of CM may be at higher risk for subsequent NCM.

OBJECTIVE

To determine whether patients with history of CM demonstrate an increased risk of second primary cutaneous, ocular, oral, or vaginal/exocervical melanoma, compared to the general population.

METHODS

This was a population-based retrospective cohort study using the Surveillance, Epidemiology, and End Results database. We calculated standardized incidence ratios (SIR) and excess absolute risks of second primary cutaneous, ocular, oral, and vaginal/exocervical melanoma in patients with a history of CM.

RESULTS

Patients with prior CM (n=169,841) were more likely than the general population to develop a second primary CM (SIR=8.17; 95% confidence interval [CI]=8.01-8.33), ocular melanoma (SIR=1.99; CI=1.54-2.53), oral melanoma (SIR=6.87; CI=2.23-16.04), and vaginal/exocervical melanoma (SIR=10.17; CI=4.65-19.30).

LIMITATIONS

This study is limited by possible underreporting of CM in cancer registries.

CONCLUSIONS

In caring for patients with a history of CM, physicians should be vigilant not only about risk of recurrence but also about second primary CM and NCM.

Journal of the American Academy of Dermatology

Risk of Second Primary Cutaneous and Non-Cutaneous Melanoma Following Cutaneous Melanoma Diagnosis: A Population-Based Study

J Am Acad Dermatol 2019 Oct 15;[EPub Ahead of Print], K Beroukhim, A Pourang, DB Eisen

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Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

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