For patients who have developed a melanoma, the risk of developing a second melanoma is 10 to 25 times greater than that for patients without a history of melanoma, the authors report.

To assess the benefits of close physician follow-up and education in such patients, lead author L. Andrew DiFronzo, MD, and his colleagues at the John Wayne Cancer Institute (JWCI) studied 51 patients who were treated at JWCI for a first melanoma, and who subsequently developed a second melanoma. The researchers compared the thickness of the first and second melanomas in these patients.

Because these patients received follow-up exams every six months and received regular patient education, this comparison allowed researchers to examine the effect of close follow-up and patient awareness and education on earlier diagnosis of second melanomas, compared with first melanomas, which are diagnosed "out of the blue," says Donald Morton, MD, medical director and surgeon-in-chief at JWCI and one of the study’s authors. "The thickness of the melanoma is an indication of how long it’s been there, and what the risk is of it spreading. If it’s a very thin melanoma, it’s highly curable in 95% or higher of the patients — whereas if it’s a thick melanoma, the chance of a cure goes down," explains Morton.

The researchers found that in 41 of these 51 patients (78.4%), the second melanomas were significantly thinner than the initial melanoma. The second melanoma was found to be thicker than the first melanoma in only four patients (7.8%).

These findings support the researchers’ idea that patient education and self-examination and careful clinical follow-up lead to earlier diagnosis of additional melanomas, leading them to advocate for such measures in all melanoma patients.

"It’s important to remain diligent and carefully examine your skin on a regular basis," says Morton. "We advise our patients to do a total skin exam at least monthly — both by themselves and by their partners looking them over carefully and charting new moles or other skin changes." Patients should inform physicians immediately of such changes.

Secondly, follow-up exams with a surgical oncologist or dermatologist at least every six months will lead to early detection and improved treatment of melanomas that may arise after the first melanoma, says Morton.

The researchers recommend that such careful surveillance should be continued over a lifetime. "Our standard policy is that once a patient has developed a melanoma, we follow them forever," Morton emphasizes.

Alan Geller, RN, MPH, a member of the American Cancer Society’s (ACS) editorial advisory committee and an associate professor at Boston University’s department of dermatology, agrees that these are important recommendations for both physicians and patients. "The physician and the newly diagnosed melanoma patient both need to be taking this very seriously. The study underscores the importance of the physician examination, [and] patients should make sure they bring any suspicious skin changes to the attention of their physicians."

The good news, says Geller, is that "if physicians and patients are working together, this study seems to indicate that the result will be thinner, curable second melanomas, should they arise."

According to the ACS Cancer Facts & Figures 2001, 51,400 persons are expected to be diagnosed with melanoma in 2001. An estimated 9,800 deaths from skin cancer are expected this year — 7,800 from melanoma and 2,000 from other forms of skin cancer. It is the most common of all cancers and accounts for about half of all cases in the US.

May is Skin Cancer Awareness Month. Learn the facts about skin cancer and how you can take steps to reduce your risk of developing it. Click the links for more information about skin cancer prevention, as well as early detection and types of treatment.