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Melanoma Skin Cancer Strikes Again
Study Shows 8% of Patients Get Melanoma Again within 2 Years of 1st Diagnosis
By Miranda HittiWebMD Medical News
Reviewed By Louise Chang, MDon Monday, April 17, 2006

April 17, 2006 -- Melanoma skin cancer may return more often than expected, experts report in the Archives of Dermatology. Melanoma is the most serious type of skin cancer. It's much rarer than nonmelanoma skin cancers. The study included 354 melanoma patients living in New Hampshire. The findings include:

27 patients (8%) had recurrent melanoma within two years of their first diagnosis.
20 patients (6%) had recurrent melanoma within a year of their first diagnosis.

Atypical moles upped the odds of recurrent melanoma. Melanoma didn't always return in the same spot. Melanoma patients should be closely monitored, and past studies have shown lower melanoma recurrence rates, note Linda Titus-Ernstoff, PhD, and colleagues. Titus-Ernstoff works in Dartmouth Medical School's community and family medicine department and the Norris Cotton Cancer Center at Dartmouth-Hitchcock Medical Center in Lebanon, N.H.

Interview and Skin Check

The researchers interviewed each patient by telephone for 40 minutes. In the interviews, participants disclosed their family history of melanoma, natural hair color at age 20, eye color, and sunburns starting when participants were 10 years old. Patients also got skin exams by doctors. For comparison, the researchers also studied 327 people with a one-time history of melanoma who did not have a history of another new melanoma. All participants were about 53 years old, on average, when they were first diagnosed. Almost all participants in both groups had at least one benign mole (96% of past melanoma patients and 94% of the comparison group); most had less than 15. Benign moles weren't associated with greater risk of melanoma recurrence -- but the same wasn't true of atypical moles.

Warning Sign

In the new study, atypical moles were linked to a higher rate of recurrent melanoma. Atypical moles have at least three of the following features: diameter larger than 5 millimeters, redness, varied colors, irregular or ill-defined borders, and a flat portion of the mole. The more atypical moles a past melanoma patient had, the greater the odds of having recurrent melanoma. Past melanoma patients with at least three atypical moles were more than four times as likely to have recurrent melanoma, compared with those with no atypical moles, the researchers write.
Atypical moles were also more common with recurrent melanoma than in the comparison group. Of the 27 patients with recurrent melanoma, 63% had at least one atypical mole. So did 37% of the comparison group.

New Location

Melanoma often recurred in new areas. Of the 27 patients with recurrent melanoma, nearly half had all their melanomas in roughly the same spot. For example, they may have had their first melanoma on the upper back and recurrent melanoma in the middle of the back. In four other patients, melanoma returned a bit farther away. They may have gotten their first melanoma on their back and later tumors on their front, or above and below the waist. Melanoma recurred in more distant locations in the other 10 patients. For instance, they may have had their first melanoma on their trunk (midsection) and recurrent melanoma on an arm. The bottom line: Melanoma can come back in new locations, so melanoma patients need close surveillance, the researchers write.

Sunburn Surprise

Excessive sun exposure has long been linked to skin cancer risk. For unknown reasons, the study showed a lower risk of melanoma recurrence in people with history of blistering sunburns
That finding should be interpreted "cautiously," the researchers write. They warn that "the association should not be construed as suggesting that sunburn protects patients with melanoma from developing additional tumors." The study doesn't track melanoma recurrence beyond two years after first diagnosis and wasn't big enough to detect subtle patterns in melanoma recurrence, note Titus-Ernstoff and colleagues.