Annals of Surgical Oncology

, Volume 19, Issue 3, pp 1024–1033 | Cite as

Clinicopathologic Features of Incident and Subsequent Tumors in Patients with Multiple Primary Cutaneous Melanomas

  • Rajmohan Murali
  • Chris Goumas
  • Anne Kricker
  • Lynn From
  • Klaus J. Busam
  • Colin B. Begg
  • Terence Dwyer
  • Stephen B. Gruber
  • Peter A. Kanetsky
  • Irene Orlow
  • Stefano Rosso
  • Nancy E. Thomas
  • Marianne Berwick
  • Richard A. Scolyer
  • Bruce K. Armstrong
  • For the GEM Study Group



0.6–12.7% of patients with primary cutaneous melanoma will develop additional melanomas. Pathologic features of tumors in patients with multiple primary cutaneous melanomas have not been well described. In this large, international, multicenter, case–control study, we compared the clinicopathologic features of a subsequent melanoma with the preceding (usually the first) melanoma in patients with multiple primary cutaneous melanomas, and with those of melanomas in patients with single primary cutaneous melanomas.


Multiple primary melanoma (cases) and single primary invasive melanoma (controls) patients from the Genes, Environment and Melanoma (GEM) study were included if their tumors were available for pathologic review and confirmed as melanoma. Clinicopathologic characteristics of invasive subsequent and first melanomas in cases and invasive single melanomas in controls were compared.


A total of 473 pairs comprising a subsequent and a first melanoma and 1,989 single melanomas were reviewed. Forward stepwise regression modeling in 395 pairs with complete data showed that, compared with first melanomas, subsequent melanomas were more commonly contiguous with a dysplastic nevus, more prevalent on the head/neck and legs than other sites, and thinner. Compared with single primary melanomas, subsequent melanomas were more likely to be associated with a contiguous dysplastic nevus, more prevalent on the head/neck and legs, and thinner. The same differences were observed when subsequent melanomas were compared with single melanomas. First melanomas were more likely than single melanomas to have associated solar elastosis and no observed mitoses.


Thinner subsequent than first melanomas suggest earlier diagnosis, perhaps due to closer clinical scrutiny. The association of subsequent melanomas with dysplastic nevi is consistent with the latter being risk factors or risk markers for melanoma.


Melanoma Prevalence Ratio Primary Melanoma Breslow Thickness Clark Level 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



This work is supported by the following NIH/NCI grants: U01 CA83180, R01 CA112425, R01 CA112243, and R01 CA112243-05S1. Professor Scolyer is a Cancer Institute New South Wales Clinical Research Fellow.


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Copyright information

© Society of Surgical Oncology 2011

Authors and Affiliations

  • Rajmohan Murali
    • 1
    • 2
    • 3
    • 14
  • Chris Goumas
    • 4
  • Anne Kricker
    • 2
    • 4
  • Lynn From
    • 5
  • Klaus J. Busam
    • 6
  • Colin B. Begg
    • 7
  • Terence Dwyer
    • 8
  • Stephen B. Gruber
    • 9
  • Peter A. Kanetsky
    • 10
  • Irene Orlow
    • 7
  • Stefano Rosso
    • 11
  • Nancy E. Thomas
    • 12
  • Marianne Berwick
    • 13
  • Richard A. Scolyer
    • 1
    • 2
    • 3
  • Bruce K. Armstrong
    • 2
    • 4
  • For the GEM Study Group
  1. 1.Tissue Pathology and Diagnostic OncologyRoyal Prince Alfred HospitalSydneyAustralia
  2. 2.Melanoma Institute AustraliaSydneyAustralia
  3. 3.Discipline of PathologyThe University of SydneySydneyAustralia
  4. 4.School of Public Health, Sydney Medical SchoolThe University of SydneySydneyAustralia
  5. 5.Women’s College HospitalTorontoCanada
  6. 6.Department of PathologyMemorial Sloan-Kettering Cancer CenterNew YorkUSA
  7. 7.Department of Epidemiology and BiostatisticsMemorial Sloan-Kettering Cancer CenterNew YorkUSA
  8. 8.Murdoch Children’s Research InstituteRoyal Children’s HospitalMelbourneAustralia
  9. 9.Division of Molecular Medicine & GeneticsUniversity of MichiganAnn ArborUSA
  10. 10.University of Pennsylvania School of MedicinePhiladelphiaUSA
  11. 11.CPO-Registro Tumori PiemonteTurinItaly
  12. 12.Department of Dermatology, Lineberger Comprehensive Cancer CenterUniversity of North CarolinaChapel Hill USA
  13. 13.Division of Epidemiology and BiostatisticsUniversity of New MexicoAlbuquerqueUSA
  14. 14.Human Oncology and Pathogenesis ProgramMemorial Sloan-Kettering Cancer CenterNew YorkUSA

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