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Two-Year Results From a Population-Based Study

Linda Titus-Ernstoff, PhD; Ann E. Perry, MD; Steven K. Spencer, MD; Jennifer Gibson, MS; Jiao Ding, MS; Bernard Cole, PhD; Marc S. Ernstoff, MD

Arch Dermatol. 2006;142:433-438.

Objective  To assess the frequency of occurrence and risk factors for multiple primary melanoma.

Design  Population-based, case-control study.

Setting  New Hampshire.

Participants  Three-hundred fifty-four New Hampshire residents with a confirmed first diagnosis of cutaneous melanoma.

Main Outcome Measure  Diagnosis of a subsequent primary cutaneous melanoma.

Results  An additional melanoma occurred in 27 individuals (8%) within 2 years of their initial diagnosis, including 20 (6%) within the first postdiagnosis year. In 9 (33%) of these 27 cases, at least 1 subsequent melanoma was deeper than the first tumor. The 27 individuals with a subsequent melanoma diagnosis were classified as "cases" and were compared on the basis of risk factors to the 327 "controls" with a single melanoma diagnosis. The data indicate an inverse relation of risk of multiple primary melanomas with multiple blistering sunburns (P = .01 for the trend); the odds ratio (OR) was 0.32 (95% confidence interval [CI], 0.11-0.93) for 2 or more sunburns compared with none. The number of atypical moles was significantly related to increased risk (P = .004 for the trend). The presence of 3 or more atypical moles compared with none was associated with more than a 4-fold risk of multiple primary melanomas (OR, 4.29; 95% CI, 1.51-12.16).

Conclusions  Additional melanomas occur more frequently than previously shown. Our study confirms that atypical moles are strongly associated with risk of multiple primary melanomas but provides little evidence that risk is influenced by pigmentary characteristics, hours of sun exposure, or benign moles. The inverse association with blistering sunburn may reflect the influence of an unmeasured covariate.

Author Affiliations: Department of Community and Family Medicine, Dartmouth Medical School, and the Norris Cotton Cancer Center (Drs Titus-Ernstoff and Cole and Mss Gibson and Ding), and Departments of Pathology (Dr Perry) and Medicine (Drs Spencer and Ernstoff), Dartmouth-Hitchcock Medical Center, Lebanon, NH.