Risk and survival of cutaneous melanoma diagnosed subsequent to a previous cancer.

OBJECTIVE To understand the risk of cutaneous melanoma (CM) following a previous cancer. DESIGN Using the Surveillance, Epidemiology, and End Results database (1988-2007), we compared a cohort of patients diagnosed as having CM as a first cancer with a cohort of patients diagnosed as having CM following a previous cancer. PARTICIPANTS We included 70,819 patients with CM as a first primary cancer and 6353 patients with CM following a previous cancer. MAIN OUTCOME MEASURES We calculated the relative risk (RR) for development of primary CM following a previous cancer and used Cox modeling to examine survival characteristics of the 2 cohorts. RESULTS Patients younger than 45 years at first cancer diagnosis had significantly higher risk of CM following cutaneous melanoma (RR, 11.89; 95% CI, 10.83-13.03), other nonepithelial skin cancer (RR, 2.81; 95% CI, 1.13-5.79), Kaposi sarcoma (RR, 3.26; 95% CI 1.41-6.42), female breast cancer (RR, 1.38; (1.11-1.70), and lymphoma (RR, 1.79; (95% CI, 1.30-2.41). Patients 45 years or older at first cancer diagnosis had significantly higher risk of CM following cutaneous melanoma (RR, 8.36; 95% CI, 7.93-8.81), other nonepithelial skin cancer (RR, 2.00; 95% CI 1.35-2.86), ocular melanoma (RR, 5.34; 95% CI 3.42-7.94), female breast cancer (RR, 1.12; 95% CI, 1.03-1.21), prostate cancer (RR, 1.08; 95% CI, 1.03-1.13), thyroid cancer (RR, 1.40; 95% CI, 1.06-1.82), lymphoma (RR, 1.34; 95% CI, 1.16-1.55), and leukemia (RR, 1.79; 95% CI, 1.49-2.13). Characteristics associated with better survival in both cohorts included female sex, age younger than 45 years at melanoma diagnosis, being married, being white vs black, decreasing Breslow depth, lack of tumor ulceration, no nodal involvement, and absence of metastases. CONCLUSION Given that cutaneous melanoma is the most common second primary cancer in patients with a first CM (a risk that remains elevated for over 15 years), our results suggest the need for continued skin surveillance in melanoma survivors.