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

SIMPLE SUMMARY: This 5-year prospective single-center follow-up study of multiple primary melanomas in two first-degree relatives with MC1R R/R genotype is an eye opener for the need of strict melanocytic lesions monitoring in high-risk patients, combining clinical expertise and different, yet synergic, skin imaging technologies. Our cohort of 60 cutaneous melanomas present in only two individuals show a high percentage (83.3%). Second primary melanomas, alas 16.7% of our cases were invasive melanomas with Breslow’s thickness up to 1.5 mm. This proportion of potentially aggressive melanomas cannot be disregarded. We bring awareness to all medical specialties, government health managers, and health care insurances for the need of rigorous monitoring of high-risk patients and their families, allowing better chances of earlier cutaneous melanoma diagnosis and longer survivals. 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.