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Friday, May 24, 2013
Skin Care and Diseases
Chances of Melanoma Recurrence
I am a fifty year old woman. At age 35 I had one instance of melanoma on my leg, which was surgically removed. Prior to developing the cancer, I had used tanning beds and tanned outdoors without sunscreen. Much wiser now, I don`t do these dangerous things anymore. At age 49, I was diagnosed with stage I aggressive breast cancer. I am now cancer free, but I am worried that my body is simply prone to cancer. I conduct self exams regularly, but I must wonder what my chances are of developing melanoma again. Are there any other preventative steps that I can take?
You bring up some interesting questions about the risks related to your previous melanoma. First, I believe your question about "developing melanoma again" is really a two-part question: (1) You may be asking what are the chances that the melanoma you had at age 35 will recur AND/OR (2) You may be asking what your chance are of developing a second, or subsequent, melanoma.
In terms of the first answer, it depends on what stage your initial melanoma was; the more advanced the stage, the higher the risk of recurrence. In terms of the second answer, data show that when an individual has had a melanoma, they are at increased risk for an additional melanoma. Melanoma survivors have about a risk about 9 times higher for a subsequent melanoma compared to the general population, and this risk remains elevated greater than 20 years after their initial diagnosis of melanoma (Bradford PT et al. 2010). Therefore, in addition to self skin exams, most dermatologists recommend at least once yearly full skin exams performed by a dermatologist, who can examine areas of the body that an individual cannot see (i.e. the scalp, back, etc). Staying out of the sun and out of tanning beds, as you are doing, is also recommended since ultraviolet radiation exposure is the primary environmental risk factor for melanoma and non-melanoma skin cancers.
In terms of the other part of your question regarding your diagnosis of breast cancer, a recent study did show that melanoma survivors were at increased risk for developing other cancers; the most common cancers were breast cancer, prostate cancer, and non-Hodgkin lymphoma (Bradford PT et al. 2010). This could be due to shared behavioral factors or genetic susceptibility or because melanoma survivors may have more medical surveillance than the general population, but nonetheless there was an increased risk seen, suggesting that melanoma survivors should not only have full skin exams on a regular basis but also surveillance for other cancers with routine recommended screening tests.
In addition to these cancers, melanoma survivors are also at increased risk of non-melanoma skin cancers, mostly basal cell carcinoma and squamous cell carcinoma. These three types of skin cancer share a common risk factor: environmental ultraviolet radiation exposure. These other types of skin cancer can also be detected during a complete skin exam by a dermatologist.
Reference: Bradford PT, Freedman DM, Goldstein AM, Tucker MA. Increased risk of second primary cancers after a diagnosis of melanoma. Archives of Dermatology March 2010;146(3):265-272.
Meg R Gerstenblith, MD
Assistant Professor of Dermatology
School of Medicine
Case Western Reserve University