- Email: [email protected]
Reply: “Risk of subsequent melanoma after melanoma in situ and invasive melanoma: A population-based study from 1973 to 2011”
Reply: ‘‘Risk of subsequent melanoma after melanoma in situ and invasive melanoma: A population-based study from 1973 to 2011’’
noma in situ patients may be as significant as or more significant than in patients with invasive melanoma.
To the Editor: We would like to thank Leitch et al for their interest and critical appraisal of the conclusion of our study. Our study showed that the patients whose first melanoma was in situ were at an increased risk of subsequent melanomas in the long run compared with those whose first melanoma was invasive.1 As Leitch et al point out, the UK and the US guidelines do not agree on follow-up strategies for patients after their invasive melanoma treatment.2-5 The US guidelines recommend a longterm follow-up of patients with invasive melanoma. Given that there are more subsequent melanomas for patients with melanoma in situ than in those with invasive melanoma and the US guidelines that already recommend lifelong follow-up after invasive melanoma, we concluded that the patients with melanoma in situ may benefit from a long-term follow-up like those with invasive melanoma. Leitch et al comment that the lower incidence of subsequent melanomas in the invasive group in our study may be due to an increased mortality in the group. We censored those who died during the follow-up period at the time of death, and the mean follow-up duration in the invasive cohort was slightly longer than that in the in situ cohort (9.8 vs 8.5 years). The regional/distant melanoma group contributed significantly to mortality in the first 2 years, but this group represented only 8% of the total. Our study is not a randomized controlled trial evaluating follow-up strategies of melanoma patients. It does not make an argument for population-wide long-term follow-up after melanoma in situ. However, it does highlight that the potential burden of subsequent melanoma in mela-
Department of Dermatology, Hofstra Northwell Health,a Lake Success, New York; Center for Dermatoepidemiology, VA Medical Center,b Departments of Dermatology and Epidemiology, Brown University,c and Department of Dermatology, Rhode Island Hospital,d Providence, Rhode Island
J AM ACAD DERMATOL
Hyemin Pomerantz, MD,a,b and Martin A. Weinstock, MD, PhDb,c,d
Funding sources: None. Conflicts of interest: None declared. Correspondence to: Hyemin Pomerantz, MD, Department of Dermatology, Hofstra Northwell Health, 1991 Marcus Ave, Suite 300, Lake Success, NY 11042 E-mail: [email protected] REFERENCES 1. Pomerantz H, Huang D, Weinstock MA. Risk of subsequent melanoma after melanoma in situ and invasive melanoma: a population-based study from 1973 to 2011. J Am Acad Dermatol. 2015;72:794-800. 2. Coit DG, Andtbacka R, Bichakjian CK, et al. Melanoma. J Natl Compr Canc Netw. 2009;7:250-275. 3. Marsden JR, Newton-Bishop JA, Burrows L, et al. Revised U.K. guidelines for the management of cutaneous melanoma 2010. Br J Dermatol. 2010;163:238-256. 4. Dummer R, Hauschild A, Guggenheim M, Keilholz U, Pentheroudakis G, ESMO Guidelines Working Group. Cutaneous melanoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2012;23: vii86-vii91. 5. Bichakjian CK, Halpern AC, Johnson TM, et al. Guidelines of care for the management of primary cutaneous melanoma. American Academy of Dermatology. J Am Acad Dermatol. 2011;65:1032-1047. http://dx.doi.org/10.1016/j.jaad.2016.06.025
OCTOBER 2016 e165
noma in situ patients may be as significant as or more significant than in patients with invasive melanoma.
To the Editor: We would like to thank Leitch et al for their interest and critical appraisal of the conclusion of our study. Our study showed that the patients whose first melanoma was in situ were at an increased risk of subsequent melanomas in the long run compared with those whose first melanoma was invasive.1 As Leitch et al point out, the UK and the US guidelines do not agree on follow-up strategies for patients after their invasive melanoma treatment.2-5 The US guidelines recommend a longterm follow-up of patients with invasive melanoma. Given that there are more subsequent melanomas for patients with melanoma in situ than in those with invasive melanoma and the US guidelines that already recommend lifelong follow-up after invasive melanoma, we concluded that the patients with melanoma in situ may benefit from a long-term follow-up like those with invasive melanoma. Leitch et al comment that the lower incidence of subsequent melanomas in the invasive group in our study may be due to an increased mortality in the group. We censored those who died during the follow-up period at the time of death, and the mean follow-up duration in the invasive cohort was slightly longer than that in the in situ cohort (9.8 vs 8.5 years). The regional/distant melanoma group contributed significantly to mortality in the first 2 years, but this group represented only 8% of the total. Our study is not a randomized controlled trial evaluating follow-up strategies of melanoma patients. It does not make an argument for population-wide long-term follow-up after melanoma in situ. However, it does highlight that the potential burden of subsequent melanoma in mela-
Department of Dermatology, Hofstra Northwell Health,a Lake Success, New York; Center for Dermatoepidemiology, VA Medical Center,b Departments of Dermatology and Epidemiology, Brown University,c and Department of Dermatology, Rhode Island Hospital,d Providence, Rhode Island
J AM ACAD DERMATOL
Hyemin Pomerantz, MD,a,b and Martin A. Weinstock, MD, PhDb,c,d
Funding sources: None. Conflicts of interest: None declared. Correspondence to: Hyemin Pomerantz, MD, Department of Dermatology, Hofstra Northwell Health, 1991 Marcus Ave, Suite 300, Lake Success, NY 11042 E-mail: [email protected] REFERENCES 1. Pomerantz H, Huang D, Weinstock MA. Risk of subsequent melanoma after melanoma in situ and invasive melanoma: a population-based study from 1973 to 2011. J Am Acad Dermatol. 2015;72:794-800. 2. Coit DG, Andtbacka R, Bichakjian CK, et al. Melanoma. J Natl Compr Canc Netw. 2009;7:250-275. 3. Marsden JR, Newton-Bishop JA, Burrows L, et al. Revised U.K. guidelines for the management of cutaneous melanoma 2010. Br J Dermatol. 2010;163:238-256. 4. Dummer R, Hauschild A, Guggenheim M, Keilholz U, Pentheroudakis G, ESMO Guidelines Working Group. Cutaneous melanoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2012;23: vii86-vii91. 5. Bichakjian CK, Halpern AC, Johnson TM, et al. Guidelines of care for the management of primary cutaneous melanoma. American Academy of Dermatology. J Am Acad Dermatol. 2011;65:1032-1047. http://dx.doi.org/10.1016/j.jaad.2016.06.025
OCTOBER 2016 e165