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Risk of subsequent melanoma after melanoma in situ and invasive melanoma: A population-based study from 1973 to 2011

Hyemin Pomerantz, MD, David Huang, MS, Martin A. Weinstock, MD, PhD

Journal of the American Academy of Dermatology, Volume 72, Issue 5, May 2015, Pages 794-800

Editors’ comment: Dr. Paolo Ascierto

In this cohort study was compared the risk for developing a new melanoma in patients with a diagnosis of melanoma in situ compared to patients with invasive melanoma. The analysis showed that patients with melanoma in situ have a higher risk of developing a new melanoma at any stage after two years from the first diagnosis as well as to develop a new invasive melanoma after 10 years from the first diagnosis of melanoma. The reasons for this phenomenon are not known, however, these results confirm the need for a follow up visit with prolonged dermatological annual even for patients with a diagnosis of melanoma in situ

Background

Patients with melanoma in situ are at an increased risk of subsequent melanoma compared with the general population, but the risk of subsequent melanoma after initial melanoma in situ versus after initial invasive melanoma is not known.

Objective

We sought to compare the risk of subsequent melanoma in the cohort whose first cancer was melanoma in situ to the risk in the cohort whose first cancer was invasive melanoma.

Methods

In this cohort study, we identified individuals whose first cancer was either melanoma in situ or invasive melanoma from the Surveillance, Epidemiology, and End Results (SEER) program between 1973 and 2011 and used Cox proportional hazards models for comparison.

Results

Compared with the invasive melanoma cohort, the melanoma in situ cohort was more likely to develop subsequent melanoma of any stage after 2 years, subsequent invasive melanoma after 10 years, and subsequent melanoma in situ at all the time points (P < .001, P = .003, P < .001, respectively).

Limitations

Underreporting of melanomas, particularly melanoma in situ cases, and missing cases of subsequent melanomas as a result of patient migration from the SEER registry areas could affect results.

Conclusion

Given the increased long-term risk of subsequent melanoma in the melanoma in situ cohort, the patients with melanoma in situ diagnosis may benefit from a long-term surveillance for subsequent melanomas.

Key words

  • invasive melanoma
  • melanoma
  • melanoma in situ
  • risk comparisons
  • Surveillance, Epidemiology, and End Results
  • subsequent melanoma

Abbreviations used

  • CI, confidence interval
  • HR, hazard ratio
  • SEER, Surveillance, Epidemiology, and End Results