Risk factors for second primary melanoma among Dutch melanoma patients

Abstract

Background

Melanoma patients are at increased risk of developing subsequent primary melanomas. Knowledge about risk factors for these subsequent primaries is scarce. More evidence may help clinicians in tailoring surveillance schedules by selecting patients who could benefit from intensified surveillance.

Objective

To identify risk factors for a second primary cutaneous melanoma.

Methods

Possible risk factors for a second primary melanoma were assessed in 1127 cutaneous melanoma patients, who were diagnosed between 2003 and 2011 and completed a baseline questionnaire. Additional data were extracted from the Netherlands Cancer Registry and medical files.

Results

Fifty-three patients were diagnosed with a second melanoma during a median follow-up time of 7.3 years. The 5-year cumulative risk was 3.7% and conditional cumulative risk was 4.6% in year 5-10 after diagnosis. In multivariable analyses, the risk of a second melanoma increased with older age at diagnosis (Hazard Ratio (HR) 1.03 per year; 95% Confidence Interval (CI) 1.00-1.06), a high nevus density (HR 7.16; 95% CI 2.89-17.75) and working outside >10 years (HR 2.88, 95% CI 1.38-6.03). Patients with invasive melanoma (> 1 mm) had a decreased risk compared to patients with melanoma in situ (HR 0.35; 95%CI:0.13-0.93).

Conclusions

Besides phenotypic characteristics, cumulative sun exposure seemed to increase the risk of a second melanoma. Patients with melanoma in situ may need to be offered follow-up, which is currently not advised. As the risk for a second melanoma did not decline in year 5-10 after diagnosis, a subgroup of patients may need a longer follow-up than is currently advised.

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