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. 2023 Oct 23;13(10):2102.
doi: 10.3390/life13102102.

Multiple Primary Melanoma: A Five-Year Prospective Single-Center Follow-Up Study of Two MC1R R/R Genotype Carriers

Ana Maria Fagundes Sortino  1   2 , Bianca Costa Soares de Sá  3 , Marcos Alberto Martins  4 , Eduardo Bertolli  2   5 , Rafaela Brito de Paula  3 , Clovis Antônio Lopes Pinto  3 , Waldec Jorge David Filho  6 , Juliana Casagrande Tavoloni Braga  3 , João Pedreira Duprat Neto  3 , Dirce Maria Carraro  3 , Maria Paula Curado  3
Affiliations

Multiple Primary Melanoma: A Five-Year Prospective Single-Center Follow-Up Study of Two MC1R R/R Genotype Carriers

Ana Maria Fagundes Sortino et al. Life (Basel). .

Abstract

Background: Multiple primary melanoma (MPM) is a diagnostic challenge even with ancillary imaging technologies available to dermatologists. In selected patients' phenotypes, the use of imaging approaches can help better understand lesion characteristics, and aid in early diagnosis and management.

Methods: Under a 5-year prospective single-center follow-up, 58 s primary melanomas (SPMs) were diagnosed in two first-degree relatives, with fair skin color, red hair, green eyes, and personal history of one previous melanoma each. Patients' behavior and descriptive demographic data were collected from medical records. The information on the first two primary melanomas (PMs) were retrieved from pathology reports. The characteristics of 60 melanomas were collected from medical records, video dermoscopy software, and pathology reports. Reflectance confocal microscopy (RCM) was performed prior to excision of 22 randomly selected melanomas.

Results: From February 2018 to May 2023, two patients underwent a pooled total of 214 excisional biopsies of suspect lesions, resulting in a combined benign versus malignant treatment ratio (NNT) of 2.0:1.0. The number of moles excised for each melanoma diagnosed (NNE) was 1.7:1.0 and 6.9:1.0 for the female and male patient respectively. The in-situ melanoma/invasive melanoma ratio (IIR) demonstrated a higher proportion of in-situ melanomas for both patients. From June 2018 to May 2023, a total of 58 SPMs were detected by the combination of total body skin exam (TBSE), total body skin photography (TBSP), digital dermoscopy (DD), and sequential digital dermoscopy imaging (SDDI) via comparative approach. The younger patient had her PM one month prior to the second and third cutaneous melanomas (CMs), characterizing a case of synchronous primary CM. The male older relative had a total of 7 nonsynchronous melanomas.

Conclusions: This CM cohort is composed of 83.3% in-situ melanoma and 16.7% invasive melanoma. Both patients had a higher percentage of SPM with clinical nevus-like morphology (84.5%), global dermoscopic pattern of asymmetric multiple component (60.3%) and located on the lower limbs (46.6%). When RCM was performed prior to excision, 81% of SPM had features suggestive of malignancy. As well, invasive melanomas were more frequent in the lower limbs (40%). In the multivariate model, for the two high-risk patients studied, the chance of a not associated with nevus ("de novo") invasive SPM diagnosis is 25 times greater than the chance of a diagnosis of a nevus-associated invasive SPM.

Keywords: MC1R; digital dermoscopy; dysplastic nevus syndrome; melanoma; multiple primary melanoma; nevus associated melanoma; reflectance confocal microscopy; second primary melanoma; sequential digital dermoscopy imaging; skin cancer; synchronous primary cutaneous melanomas; total body skin photograph.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Heredogram of family studied.
Figure 2
Figure 2
Proportion of histological diagnosis of 214 excised lesions, by patient gender, from February 2018 to May 2023.
Figure 3
Figure 3
Proportion of melanomas diagnosed from February 2018 to May 2023.
Figure 4
Figure 4
Total number (light orange bars) and percentages (dark orange bars) of 8 synchronous SPMs diagnosed on the female patient, at first and third month. Their location, clinical pattern, pigmentation, palpability, borders, global dermoscopic pattern and histological association with nevus are summarized above.
Figure 5
Figure 5
Distribution of three morphological clusters (clinical patterns) found on 60 cutaneous melanomas, for both genders.
Figure 6
Figure 6
Distribution of global dermoscopic patterns found on 60 cutaneous melanomas, for both genders.
Figure 7
Figure 7
Frequency of 17 melanoma-specific dermoscopic structures found, in both in-situ and invasive melanomas, on our cohort of 58 SPMs.
Figure 8
Figure 8
Frequency of 13 melanoma-specific dermoscopic structures found on our cohort of 10 invasive SPMs.
Figure 9
Figure 9
Curves of the quadratic model for daughter and father: number of melanomas as a function of time (in months).
See this image and copyright information in PMC

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