Risk of second primary malignancies following cutaneous melanoma diagnosis: A population-based study - 24/04/13

Doi : 10.1016/j.jaad.2009.07.039

Joshua P. Spanogle, MD ^a, Christina A. Clarke, PhD, MPH ^b,^c, Sarah Aroner, BA ^b, Susan M. Swetter, MD ^a,^c,^d,^⁎
^a Department of Dermatology, Pigmented Lesion and Melanoma Program, Stanford University Medical Center, Stanford, California
^b Northern California Cancer Center, Fremont, California
^c Stanford Comprehensive Cancer Center, Stanford, California
^d Veterans Affairs Palo Alto Health Care System, Palo Alto, California

Correspondence to: Susan M. Swetter, MD, Department of Dermatology, Stanford University Medical Center, 900 Blake Wilbur Dr, W0069, Stanford, CA 94305.

Abstract

Background

Understanding risk patterns for developing a second primary malignancy (SPM) after cutaneous melanoma (CM) has implications for both research and clinical practice, including cancer screening.

Objective

We sought to describe incidence patterns of SPMs occurring after CM.

Methods

We calculated incidence rates and relative risks for the development of 65 different SPMs occurring in 16,591 CM survivors during 1.3 million person-years of observation in the Surveillance, Epidemiology, and End Results program data from 1973 to 2003.

Results

Compared with the general population, CM survivors had a 32% higher risk of developing any SPM and demonstrated significantly elevated risks for 13 cancers: melanoma of the skin (standardized incidence ratio [SIR] 8.99), soft tissue (SIR 2.80), melanoma of the eye and orbit (SIR 2.64), nonepithelial skin (SIR 2.31), salivary gland (SIR 2.18), bone and joint (SIR 1.70), thyroid (SIR 1.90), kidney (SIR 1.29), chronic lymphocytic leukemia (SIR 1.29), brain and nervous system (SIR 1.31), non-Hodgkin lymphoma (SIR 1.25), prostate (SIR 1.13), and female breast (SIR 1.07). Risks of second primary melanoma of the skin, melanoma of the eye and orbit, and cancers of the prostate, soft tissue, salivary gland, and bone and joint were elevated throughout the study period, implying no surveillance bias.

Limitations

Possible underreporting of CM incidence in cancer registries is a limitation. In addition, the lack of individual-level data in cancer registry data precludes detailed examination of coincident risk factors.

Conclusion

Risks of particular SPMs after CM may be explained by surveillance bias or shared risk factors. However, these probably do not explain the increased risks observed for prostate, soft tissue, salivary gland, and bone and joint cancers years after CM diagnosis. Further investigation into genetic or environmental commonalities between CM and these cancers is warranted.

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Key words : cutaneous melanoma, melanoma, melanoma survivorship, second primary malignancy, Surveillance, Epidemiology, and End Results program

Abbreviations used : CI, CM, NHL, SEER, SES, SIR, SPM, UV

Plan

	Dr Spanogle is currently affiliated with the Department of Dermatology, Mayo Clinic, Rochester, MN. Ms Aroner is currently affiliated with the Department of Epidemiology, Harvard School of Public Health, Boston, MA.
	Supported by the National Cancer Institute’s Surveillance, Epidemiology, and End Results Program under contract N01-PC-35136 awarded to the Northern California Cancer Center. The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the State of California, the California Department of Public Health, the National Cancer Institute, and the Centers for Disease Control and Prevention or their contractors and subcontractors. Endorsement by any of those agencies is not intended nor should it be inferred.
	Conflicts of interest: None declared.
	Reprints not available from the authors.