Win Myint Thu Thu, Selak Vanessa, Elwood Mark
Department of Biostatistics and Epidemiology University of Auckland Auckland New Zealand.
Skin Health Dis. 2022 May 13;3(2):e116. doi: 10.1002/ski2.116. eCollection 2023 Apr.
Patients with invasive melanoma are at increased risk of developing subsequent invasive melanoma, but the risks for those with primary in situ melanoma are unclear.
To assess and compare the cumulative risk of subsequent invasive melanoma after primary invasive or in situ melanoma. To estimate the standardized incidence ratio (SIR) of subsequent invasive melanoma compared to population incidence in both cohorts.
Patients with a first diagnosis of melanoma (invasive or in situ) between 2001 and 2017 were identified from the New Zealand national cancer registry, and any subsequent invasive melanoma during follow-up to the end of 2017 identified. Cumulative risk of subsequent invasive melanoma was estimated by Kaplan-Meier analysis separately for primary invasive and in situ cohorts. Risk of subsequent invasive melanoma was assessed using Cox proportional hazard models. SIR was assessed, allowing for age, sex, ethnicity, year of diagnosis and follow up time.
Among 33 284 primary invasive and 27 978 primary in situ melanoma patients, median follow up time was 5.5 and 5.7 years, respectively. A subsequent invasive melanoma developed in 1777 (5%) of the invasive and 1469 (5%) of the in situ cohort, with the same median interval (2.5 years) from initial to first subsequent lesion in both cohorts. The cumulative incidence of subsequent invasive melanoma at 5 years was similar in the two cohorts (invasive 4.2%, in situ 3.8%); the cumulative incidence increased linearly over time in both cohorts. The risk of subsequent invasive melanoma was marginally higher for primary invasive compared to in situ melanoma after adjustment for age, sex, ethnicity and body site of the initial lesion (hazard ratio 1.11, 95% CI 1.02-1.21). Compared to population incidence, the SIR of invasive melanoma was 4.6 (95% CI 4.3-4.9) for the primary invasive and 4 (95% CI 3.7-4.2) for the primary in situ melanoma cohorts.
The risk of subsequent invasive melanoma is similar whether patients present with in situ or invasive melanoma. Thus follow-up surveillance for new lesions should be similar, although patients with invasive melanoma require more surveillance for recurrence.
侵袭性黑色素瘤患者发生后续侵袭性黑色素瘤的风险增加，但原发性原位黑色素瘤患者的风险尚不清楚。
评估和比较原发性侵袭性或原位黑色素瘤后发生后续侵袭性黑色素瘤的累积风险。估计两个队列中后续侵袭性黑色素瘤与总体人群发病率相比的标准化发病比（SIR）。
从新西兰国家癌症登记处识别出2001年至2017年间首次诊断为黑色素瘤（侵袭性或原位）的患者，并确定随访至2017年底期间任何后续的侵袭性黑色素瘤。分别对原发性侵袭性和原位队列采用Kaplan-Meier分析估计后续侵袭性黑色素瘤的累积风险。使用Cox比例风险模型评估后续侵袭性黑色素瘤的风险。评估SIR，并考虑年龄、性别、种族、诊断年份和随访时间。
在33284例原发性侵袭性黑色素瘤患者和27978例原发性原位黑色素瘤患者中，中位随访时间分别为5.5年和5.7年。侵袭性队列中有1777例（5%）发生了后续侵袭性黑色素瘤，原位队列中有1469例（5%）发生了后续侵袭性黑色素瘤，两个队列中从初始病变到首次后续病变的中位间隔时间相同（2.5年）。两个队列中5年时后续侵袭性黑色素瘤的累积发病率相似（侵袭性为4.2%，原位为3.8%）；两个队列中的累积发病率均随时间呈线性增加。在对年龄、性别、种族和初始病变的身体部位进行调整后，原发性侵袭性黑色素瘤发生后续侵袭性黑色素瘤的风险略高于原发性原位黑色素瘤（风险比1.11，95%可信区间1.02-1.21）。与总体人群发病率相比，原发性侵袭性黑色素瘤队列中侵袭性黑色素瘤的SIR为4.6（95%可信区间4.3-4.9），原发性原位黑色素瘤队列中为4（95%可信区间3.7-4.2）。
无论是原位黑色素瘤患者还是侵袭性黑色素瘤患者，发生后续侵袭性黑色素瘤的风险相似。因此，对新病变的随访监测应相似，尽管侵袭性黑色素瘤患者需要更多的复发监测。
