MULTIPLE PRIMARY MELANOMAS - IMPLICATIONS FOR SCREENING AND FOLLOW-UPPROGRAMS FOR MELANOMA

Background: Once individuals are diagnosed with malignant melanoma, th ey are at an increased risk of developing another melanoma when compar ed with the normal population. Methods: To determine the impact of an intensive follow-up protocol on the stage of disease at diagnosis of s ubsequent primary melanomas, a retrospective query was performed of an electronic medical record database of 2,600 consecutively registered melanoma patients. Results: Sixty-seven patients (2.6%) had another me lanoma diagnosed at the time of presentation to the clinic or within 2 months (synchronous) and another 44 patients (1.7%) developed a secon d primary melanoma during the follow-up period (metachronous). For the 44 patients diagnosed with metachronous lesions, the Breslow mean tum or thickness for the first invasive melanoma was 2.27 mm compared with 0.90 mm for the second melanoma. The first melanomas diagnosed are th icker by an average of 3.8 mm (p = 0.008). The mean Clark level for th e initial melanoma was greater than the mean level for subsequently di agnosed melanomas (p = 0.002). Twenty-three percent of the initial mel anomas were ulcerated, whereas only one of the second primary lesions showed this adverse prognostic factor (p = 0.002). Conclusions: Once i ndividuals are diagnosed with melanoma, they are in a high-risk popula tion for having other primary site melanomas diagnosed and should be p laced in an intensive follow-up protocol consisting of a complete skin examination.