Clinical Characteristics and Impact on Prognosis of Melanoma Accompanied by Multiple Primary Malignancies: A Retrospective Analysis

INTRODUCTION

This study aims to explore the clinical characteristics and prognosis of patients with melanoma (MM), which are composed mainly of acral and mucosal MM accompanied by multiple primary tumors.

METHODS

A total of 87 patients diagnosed with single primary MM and 87 patients diagnosed with multiple primary malignant tumors were included. Nonmelanoma malignancy tumor type, genetic testing, and the survival data were collected. Pearson's chi-square test, Fisher's exact test, log-rank test, univariate and multivariate Cox's regression analysis were applied.

RESULTS

The most common nonmelanoma malignancies in all patients involved the digestive system; breast cancer, thyroid cancer, lung cancer, and prostate cancer; and breast cancer was more common in patients with acral MM. Mutations in BRAF V600, NRAS, KIT, and TP53 were the most common. Univariate analysis revealed that mutations in KIT and elevated levels of lactate dehydrogenase (LDH) were potential factors that influenced OS. Multivariate analysis revealed that mutations in NRAS and increased LDH levels were related to worse survival and that survival was prolonged in patients with MM as the first primary tumor.

CONCLUSION

This study preliminarily describes the clinical features and prognosis of patients with melanomas, while the further study with larger sample size is needed.

Melanoma in older adolescents and young adult patients: A population-based analysis of the Surveillance, Epidemiology, and End Results Program database from 2000 to 2019

Epidemiologic characteristics of melanoma in older adolescents and young adult (AYA) patients aged 15 to 39 years are unknown. We examined the epidemiologic characteristics of melanoma in AYA patients and then extracted demographic and pathologic data for this retrospective cohort study from the Surveillance, Epidemiology, and End Results database (2000-2019). Cox regression analyses were used to assess the risk of all-cause death, cancer-specific death, and second primary malignancy. A total of 2,835 AYA patients with melanoma were included, of whom 926 (32.66%) had a second primary malignancy. The incidence of melanoma in AYA patients decreased from 0.9 per 1,000,000 person-year in 2000 to 0.2 per 1,000,000 person-year in 2019, with an average annual percentage change of -6.3% (95% CI, -7.2% to -5.3%). Melanoma patients who were darker skinned (Black) (hazard ratio, 3.794; 95% CI, 1.382-10.412) were associated with an increased risk of second primary malignancies, whereas patients with a Breslow depth of >4 mm (hazard ratio, 0.517; 95% CI, 0.379-0.706), melanoma site on the trunk (hazard ratio, 0.700; 95% CI, 0.536-0.915), and extremities (hazard ratio, 0.760; 95% CI, 0.585-0.988) were associated with a decreased risk of second primary malignancies. This study may provide statistical data on the epidemiologic characteristics of melanoma in AYA patients.

Incidental detection of non-melanoma neoplasms in sentinel lymph node biopsy for melanoma staging: A retrospective case series

BACKGROUND

Patients with malignant melanoma have an increased risk of developing secondary hematologic malignancy, and patients with hematologic malignancies have an increased risk of developing melanoma. Rarely, sentinel lymph node biopsies (SLNBs) collected for melanoma staging might harbor lymphoma or even carcinoma, which may represent a second primary malignancy (SPM). Biopsied lymph node(s) might serve as the first site of recognition for a SPM. Yet, there has been little systematic investigation regarding the characteristics of incidental SPMs detected on SLNB for melanoma staging.

METHODS

A series of cases of lymphomas and carcinomas were detected incidentally during SLNB for melanoma staging from two tertiary academic centers between 2000 and 2021.

RESULTS

Fifteen cases of incidentally detected SPMs were reviewed, comprising 12 lymphomas and three carcinomas. The most common incidentally detected second malignancy was chronic lymphocytic leukemia/small lymphocytic lymphoma (60%, 9/15). There were three cases of incidentally detected metastatic carcinoma. Of all incidentally detected malignancies, 2/3 carcinomas and 4/12 lymphomas represented first-time diagnoses of SPM in a melanoma patient. Forty percent of cases (6/15) also harbored metastatic melanoma in the sentinel lymph node.

CONCLUSIONS

It is possible to incidentally detect SPMs in SLNBs for melanoma staging. Early detection of SPMs in melanoma patients has implications for the treatment of both incidental SPM and melanoma.

Predictive models for overall survival in breast cancer patients with a second primary malignancy: a real-world study in Shanghai, China

BACKGROUND

The incidents of second primary malignancy (SPM) is increasing among breast cancer (BC) patients with long-term progression, adversely affecting survival. The purpose of this study was to screen independent overall survival (OS) risk factors and establish nomograms to predict the survival probabilities of BC patients with SPM.

METHOD

A total of 163 BC patients with SPM were recruited during 2002-2015 from a total of 50 hospitals in Shanghai, China. Two nomograms to predict survival from primary BC and SPM diagnosis were constructed based on independent factors screened from multivariable analysis. The calibration and discrimination of nomograms were calculated in the training and validation cohorts.

RESULTS

The overall survival rates of BC patients with SPM were 88.34%, 64.42% and 54.66% at 5, 10 and 15 years, respectively. Factors of late TNM stage of SPM (HR = 4.68, 95% CI 2.14-10.25), surgery for SPM (HR = 0.60, 95% CI 0.36-1.00), SPM in the colon and rectum (HR = 0.49, 95% CI 0.25-0.98) and thyroid (HR = 0.08, 95% CI 0.01-0.61) independently affected the OS of BC patients with SPM (p < 0.05). In addition, a longer latency (≥ 5 years) was associated with better OS from BC diagnosis (p < 0.001). Older age (≥ 56) was associated with poor OS from SPM diagnosis (p = 0.019). Two nomograms established based on the above factors had better calibration and discrimination.

CONCLUSION

The TNM stage of SPM, surgery for SPM, SPM sites, latency and age at BC diagnosis are independent factors for survival and the two nomograms may provide more personalized management for BC patients with SPM.

Melanoma survivors are at increased risk for second primary keratinocyte carcinoma

BACKGROUND

Recent large cohorts have reported that melanoma survivors are at risk of developing second keratinocyte carcinoma (KC). However, the detailed proportion and risk are still unknown. We aimed to comprehensively analyze the risk of developing keratinocyte carcinoma after primary melanoma.

METHODS

We conducted systematic literature research in PubMed, Embase, Web of Science, and Cochrane Library published prior to September 13, 2021. Proportion and standardized incidence ratios (SIR) with its corresponding 95% confidence interval (CI) were pooled for assessing the risk.

RESULTS

A total of 15 studies encompassing 168,286 patients were included in our analysis. The pooled proportions of melanoma survivors that developed a subsequent basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and KC were 4.11% (95% CI, 1.32-6.90), 2.54% (95% CI, 1.78-3.31), and 5.45% (95% CI, 3.06-7.84), respectively. The risks of developing a second BCC, SCC, and KC in melanoma survivors were 5.3-fold (SIR 5.30; 95% CI, 4.87-5.77), 2.6-fold (SIR 2.58; 95% CI, 1.33-5.04), and 6.2-fold (SIR 6.17; 95% CI, 3.66-10.39) increased in comparison with the general population. Both fixed effects and random effects models were applied in conducting meta-analysis and reached a consistent conclusion.

CONCLUSIONS

Our results indicated melanoma survivors are at elevated risk of experiencing second primary BCC and SCC, which suggested the significance of surveillance for second primary KC and efforts for prevention in patients with a history of melanoma.

Second Primary Malignancies in Patients With Melanoma Subtypes: Analysis of 120,299 Patients From the SEER Database (2000-2016)

Purpose

Evaluate incidence of second primary malignancies (SPM) after non-acral cutaneous melanoma (NACM), acral lentiginous melanoma (ALM), mucosal melanoma (MM), and uveal melanoma (UM).

Patients and Methods

First primary NACM, ALM, MM, and UM cases diagnosed 2000-2016 were extracted from SEER. Seer*Stat was used to calculate excess absolute risks (EAR) and standardized incidence ratios (SIR) of SPMs relative to a matched cohort from the general population. P-value of 0.05 determined significance.

Results

Inclusion criteria was met by 109,385 patients with NACM, 2166 with ALM, 2498 with MM, and 6250 with UM. Increased incidence of malignancies occurred after NACM (SIR 1.51; 95%CI, 1.49-1.54), ALM (SIR 1.59; 95%CI, 1.40-1.81), MM (SIR 2.14; 95%CI, 1.85-2.45), and UM (SIR 1.24; 95%CI, 1.14-1.34) relative to the general population. Cutaneous melanoma occurred more frequently after NACM (SIR 9.54; 95%CI, 9.27-9.83), ALM (SIR 12.19; 95%CI, 9.70-15.14), MM (SIR 10.05; 95%CI, 7.18-13.68), and UM (SIR 2.91; 95%CI, 2.27-3.66). Patients with initial NACM (SIR 2.44; 95%CI, 1.64-3.51) and UM (SIR 44.34; 95%CI, 29.91-63.29) demonstrated increased incidence of eye and orbit melanoma. Renal malignancies occurred more frequently after NACM (SIR 1.24; 95%CI, 1.11-1.38), MM (SIR 3.54; 95%CI, 1.62-6.72) and UM (SIR 1.68; 95%CI, 1.09-2.48). Increased incidence of thyroid malignancies was observed after NACM (SIR 1.83; 95%CI, 1.61-2.06), ALM (SIR 3.74; 95%CI, 1.71-7.11), MM (SIR 4.40; 95%CI, 1.77-9.06), and UM (SIR 3.79; 95%CI, 2.52-5.47). Increased incidence of lymphoma was observed after NACM (SIR 1.20; 95%CI, 1.09-1.31) and ALM (SIR 2.06; 95%CI, 1.13-3.46).

Conclusion

Patients with NACM, ALM, MM, and UM have increased incidence of SPMs compared to that expected from the general population. Each of these melanoma subtypes had increased occurrence of cutaneous melanoma and thyroid cancer; some, but not all, had increased occurrence of renal malignancies, eye and orbit melanoma, and lymphoma.

Second Primary Malignancies in Patients with Pancreatic Neuroendocrine Neoplasms: A Population-Based Study on Occurrence, Risk Factors, and Prognosis

Background

This study aimed to evaluate the risk factors of developing second primary malignancies (SPMs) among patients with pancreatic neuroendocrine neoplasms (pNENs) and the prognosis of pNENs patients with SPMs (pSPMs) using data from the Surveillance, Epidemiology, and End Results (SEER) database.

Methods

Data from patients diagnosed with pNENs between 1988 and 2016 were extracted. A case-control study was conducted to investigate the risk factors of developing SPMs among patients with pNENs. Meanwhile, cox regression analysis was also conducted to obtain the independent prognostic factors in pSPMs.

Results

Of 7,630 patients with pNENs, 326 developed SPMs. Patients with pNENs who had not undergone surgery and had been diagnosed in recent periods had a higher risk of developing SPMs. The following independent prognostic predictors for pSPMs were identified: age, latency period, SEER stage, radiotherapy, and surgery.

Conclusions

These findings may improve the surveillance of risk factors for developing SPMs in patients with pNENs and the prognostic risk factors in pSPMs.

Survival and medical costs of melanoma patients with subsequent cancer diagnoses: A South Korean population-based retrospective cohort study

Aim

Subsequent cancers (SCs) after melanoma diagnosis further increases the risks of mortality and medical costs. This population‐based analysis aimed to evaluate risk factors for SC, mortality, and medical costs of melanoma patients with SC.

Methods

A retrospective cohort analysis was conducted using a nationwide claims database during 2002‐2017 in South Korea. SC was defined as having other types of cancer diagnoses other than subsequent melanoma during‐up to 5 years after melanoma diagnosis. Melanoma patients were divided into patients with and without SC, and the overall and subgroup survival rates, the risk of developing SC, and the total medical costs were analyzed using a Kaplan–Meier method and regressions.

Results

A total of 3740 melanoma patients were included in the analysis (mean age, 62.3 ± 15.4 y; 47.2% men), and 2273 patients (1157 within 2 months, 756 after 2 months of melanoma diagnosis) had SC. Higher Charlson comorbidity index score and male sex significantly increased the risk of developing SC. Five‐year survival rate and cumulative medical costs were 62.3% (95% confidence interval [CI], 60.8‐63.9) and $21,413, respectively, in all patients. Patients with SC diagnosed after 2 months showed the lowest survival rate of 47.8% (95% CI, 44.3‐51.4) and the highest costs of $27,081, showing a mortality hazard ratio of 1.65 (range, 1.46‐1.86) and a cost ratio of 1.189 (range, 1.112‐1.271) compared with those without SC.

Conclusion

This study presented survival outcomes and medical costs in melanoma patients and confirmed that SC after the first diagnosis of melanoma significantly increased disease burden in terms of mortality and medical costs.

Immune checkpoint inhibitor treatment of a first cancer is associated with a decreased incidence of second primary cancer

Background

Second primary cancers (SPCs) are diagnosed in over 5% of patients after a first primary cancer (FPC). We explore here the impact of immune checkpoint inhibitors (ICIs) given for an FPC on the risk of SPC in different age groups, cancer types and treatments.

Patients and methods

The files of the 46 829 patients diagnosed with an FPC in the Centre Léon Bérard from 2013 to 2018 were analyzed. Structured data were extracted and electronic patient records were screened using a natural language processing tool, with validation using manual screening of 2818 files of patients. Univariate and multivariate analyses of the incidence of SPC according to patient characteristics and treatment were conducted.

Results

Among the 46 829 patients, 1830 (3.9%) had a diagnosis of SPC with a median interval of 11.1 months (range 0-78 months); 18 128 (38.7%) received cytotoxic chemotherapy (CC) and 1163 (2.5%) received ICIs for the treatment of the FPC in this period. SPCs were observed in 7/1163 (0.6%) patients who had received ICIs for their FPC versus 437/16 997 (2.6%) patients receiving CC and no ICIs for the FPC versus 1386/28 669 (4.8%) for patients receiving neither CC nor ICIs for the FPC. This reduction was observed at all ages and for all histotypes analyzed. Treatment with ICIs and/or CC for the FPC are associated with a reduced risk of SPC in multivariate analysis.

Conclusion

Immunotherapy with ICIs alone and in combination with CC was found to be associated with a reduced incidence of SPC for all ages and cancer types.

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From 2013 to 2018, 3.9% of the 46 829 patients diagnosed with a first cancer presented with an SPC.

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Treatment of the first cancer with ICIs was associated with a major reduction of SPC.

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CC given for an FPC was also associated with a lower magnitude of reduction of SPC.

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There were no SPC in cancer patients treated with ICIs in the localized phase of their first cancer.