NEWS, VIEWS & REVIEWS
March 2011 | Volume 10 | Issue 3 | Original Article | 320 | Copyright © March 2011
News, Views and Reviews provides focused updates, topic reviews and editorials concerning the latest developments in dermatologic therapy.
Second Cancers After
For Which Cancers Are
Melanoma Patients at
Higher Risk? Which
Cutaneous melanoma is often diagnosed in young and middleaged
individuals. After a melanoma diagnosis, patients are
understandably concerned about their risk of a second melanoma
and about cancers of all types. After treatment of a primary
cancer, the focus for many people moves to detection
and prevention of further malignancies. Conversely, patients
diagnosed with other cancers may be concerned about their
risk of melanoma. Recently, several population-based studies
have confirmed associations between melanoma and particular
types of other cancer. Genetic links are being identified between
melanoma and other cancers.
For many young patients, a skin cancer diagnosis is their first
personal cancer diagnosis. This news can strike people in different
ways, and fortunately many become motivated to focus
on early skin cancer detection and prevention of further skin
cancers. As with any diagnosis of “cancer,” questions are often
raised about the risks of other types of cancer for an individual
or their family members.
For patients with other primary cancers, the risk of developing
melanoma is increased relative to the general population.
As the incidence of melanoma increases and survival rates increase
for patients with melanoma, more and more people are
living longer after a melanoma diagnosis. Knowing the relative
risks of different cancers for an individual with a history of
melanoma can help allay fears and promote age-appropriate
Association of Melanoma With Other Cancers
Previous studies have found a link between an initial cutaneous
malignant melanoma diagnosis and later diagnosis
of lymphoma,1,2 breast cancer,3–5 thyroid cancer,6 pancreatic
cancer,7–9 bladder cancer,10 and nervous system cancer,11 as
well as second primary melanoma12,13 and non-melanoma
Fortunately, researchers in the United States (U.S.) and beyond
are utilizing large and now-long-term databases to assess relative
risks of different cancers. In the United States, the National
Cancer Institute's SEER (Surveillance, Epidemiology, and End
Results) database tracks de-identified data for all cancer diagnoses
in 17 geographical areas from 1973 to the present. The
malignancies are reported to the SEER database by diagnosing
pathologists, and the SEER organization collects clinical information
and de-identifies patient information into a database.
This database is updated and a new set is released annually.
Researchers can query this database to look at cancer incidence,
outcomes, and reports of issues such as second primary
malignancies. Patients are followed annually with the SEER database
until their death or are lost to follow up for other reasons
such as a move out of the geographic area.
Geographical regions represented by the SEER database include
Atlanta, GA; Detroit, MI; the San Francisco Bay Area; Los
Angeles, CA; the State of Hawaii; the State of Iowa; the State of
Kentucky; the State of Louisiana; the State of New Jersey; the
State of New Mexico; the Seattle-Puget Sound region; and the
State of Utah.
In addition to geographical regions, different databases track
cancers in Native American populations. Separate registries
track cancers among the Alaska native population, Arizona Indian
population, and the Cherokee Nation.
On an international level, the International Agency for Research
on Cancer (IARC) aggregates data from 13 non-U.S. cancer
registries that have been in operation for at least 25 years. The
registries include New South Wales in Australia, British Columbia,
Manitoba and Saskatchewan in Canada, Denmark, Finland,
Iceland, Norway, Scotland, Singapore, Slovenia, Sweden and
Zaragoza in Spain. These registries follow cancer data covering
different time periods beginning in 1943.
The largest database query to date of SEER regarding melanoma
was recently published. Spanogle et al. at Stanford University16 analyzed 151,996 individuals with a diagnosis of cutaneous
malignant melanoma in the SEER database between
1973 and 2003. This population was larger than previously per-