A single-institution case series of patients with cutaneous melanoma and non-Hodgkin's lymphoma

Metachronous primary melanoma and lymphoma

The association of cutaneous melanoma and non-Hodgkin lymphoma has been well documented. We identified 117 patients from the Connecticut Tumor Registry between 1973 and 2002 with diagnoses of both melanoma and non-Hodgkin lymphoma. Charts were reviewed based on patients identified with these diagnoses in the Tumor Registry at Yale-New Haven Hospital between 1926 and 2004. Data were analyzed for age at diagnosis, interval between diagnoses, survival, and gender comparisons were also made. Males comprised 62% of the patients. Females diagnosed initially with non-Hodgkin lymphoma developed melanoma after a longer interval than males. All patients diagnosed with non-Hodgkin lymphoma first had decreased survival. No gender-specific survival difference was seen regardless of which malignancy occurred first. The study patients had overall decreased survival than that expected with either melanoma or non-Hodgkin lymphoma alone. The effects of treatment, immunosuppression, viral induction, and genetic mutations may play various roles in the development of these neoplasms. Further research is required to provide insight into the link between melanoma and non-Hodgkin lymphoma.

Association between lymphoma and melanoma: report of a single-center series of eight patients and a review of the literature

Epidemiologic studies have reported an association between lymphoid neoplasia and melanoma. However, the clinical characteristics, medical history and outcome of patients presenting both diseases have not been clearly described. Patients who developed both lymphoma and melanoma at the Institut Curie between 1970 and 2005 were included in this retrospective study. Patient characteristics were analysed and a review of all previously published cases was then performed. The eight patients of our series and those derived from a review of the literature resulted in a population of 70 patients. The male/female sex ratio was greater than 1. Patients were older than 50 years. The mean interval to the second malignancy was 5 years and 13 years for lymphoma and melanoma, respectively. Most patients had an indolent B-cell lymphoma and localized melanoma. Frequent skin involvement was reported for T-cell lymphoma. Chemotherapy or external radiation therapy frequently preceded the second malignancy. Patients with lymphoma and melanoma should be closely monitored to detect the appearance of a second malignancy. Further studies are therefore warranted to elucidate this peculiar association.

Sub-clinical dissemination of follicular lymphoma in normal sized lymph nodes may not be detected by radiologic staging: a case of disseminated follicular lymphoma detected in nodal clearance as part of therapy for cutaneous melanoma

Patients with localized follicular lymphoma are potentially curable; however, the failure rate for local treatment suggests that a proportion of apparently localized disease is being under-staged. We report a case of incidentally diagnosed follicular lymphoma found in association with a stage II malignant melanoma, with immunohistochemical evidence of disseminated lymphoma in radiologically and clinically benign regional lymph nodes. This case provides some evidence to the cause of treatment failure in patients with clinically localized follicular lymphoma, and is a histologically proven example of the association between melanoma and lymphoma.

Diagnosis of lymphoma in the draining lymph node basin at the time of in-transit metastasis of cutaneous melanoma

The association between cutaneous melanoma and non-Hodgkin's lymphoma (NHL) has been described. Herein we describe two cases in which lymphoma was detected in the draining lymph node basin at the time of the finding of in-transit metastasis of cutaneous melanoma. In both of these cases, sentinel lymph node biopsy at the time of the excision of the primary melanoma showed no evidence of metastatic melanoma or lymphoma. The temporal and spatial correlation of melanoma and NHL in these two cases suggests the possibility of a local failure in immune surveillance.

The association between malignant melanoma and noncutaneous malignancies

BACKGROUND

Both increases and decreases in the incidence of subsequent malignancies in melanoma patients have been reported. We examined the database of the Indiana University Cancer Center to determine whether there is an association between malignant melanoma and noncutaneous malignancies.

OBJECTIVE

We searched for evidence of noncutaneous malignancies in a cohort of melanoma patients.

METHODS

Patients with microscopically confirmed malignant melanoma diagnosed between January 1987 and March 2001 were analyzed. This cohort was investigated for noncutaneous malignancies occurring either before or after the diagnosis of melanoma. The standardized incidence ratios (SIR) were calculated as the ratio of the observed to the expected number of patients with second malignancies, and 95% confidence intervals (95% CI) around the SIR were estimated from the cumulative Poisson distribution.

RESULTS

A total of 955 patients with melanoma (498 males and 457 females) were documented over the 14-year period. Sixty-nine noncutaneous malignancies were identified in 59 (6.2%) melanoma patients (39 males and 20 females). There was a higher risk of non-Hodgkin's lymphoma (SIR = 1.91; 95% CI, 0.88-3.62) in men and renal cell carcinoma (SIR = 2.41, 95% CI, 0.97-4.97) in men. In female patients, however, there was no higher risk of noncutaneous malignancies.

CONCLUSIONS

This study did not show a higher risk of prostate cancer, gastrointestinal cancer, leukemia, endometrial cancer, or cancer of the nerve and neuroendocrine systems in melanoma patients. No female patients incurred a higher risk of noncutaneous cancers. The increased risk of non-Hodgkin's lymphoma and renal cell carcinoma in men might be attributed to a mutual carcinogenic exposure, an aberration of cell-mediated immunity, a shared genetic susceptibility, increased medical surveillance among cancer patients, a post-therapy effect after cancer management, or factors not as yet clear. Close monitoring of melanoma patients for signs of second malignancy is warranted.

Skin cancer and non-Hodgkin's lymphoma: examining the link

BACKGROUND

The incidence rates of melanoma and non-Hodgkin's lymphoma (NHL) have increased substantially worldwide over the past several decades. It has been hypothesized that ultraviolet light exposure through sunlight may be a common environmental risk factor shared by both skin cancer and NHL.

OBJECTIVE

The purpose of this study was to better understand the association between skin cancer and NHL and to evaluate its implication in clinical practice.

METHODS

We reviewed the current literature on the link between the two malignancies and on the role of ultraviolet light in the development of NHL. Publications were selected using a PUBMED search with the terms "non-Hodgkin's lymphoma" and "skin cancer." Epidemiologic studies in English and published after 1995 were the focus.

CONCLUSIONS

Large population-based studies support an increased risk of subsequent NHL among patients with skin cancers (both melanoma and nonmelanoma skin cancers) and a risk of skin cancer development in patients with NHL, although support for a direct relationship between ultraviolet light and the incidence of NHL is weak and inconsistent. Given their increased risk of developing skin cancers, patients with a history of NHL may benefit from a full-body examination during their visits.

Fréquence des cancers associés dans les lymphomes cutanés

INTRODUCTION

The initial staging and follow-up of cutaneous lymphomas is far from being standardized. In this retrospective study, we describe the results of systematic laboratory investigations dedicated to a better definition of the TNM stage for the detection of associated malignancies.

PATIENTS AND METHODS

This was a retrospective, descriptive, single centre study, including all cases of cutaneous lymphomas seen in the department of dermatology, university hospital of Reims, between 1987 and 2001. Data systematically recorded for each patient included clinical, biological, histological and molecular (cutaneous or circulating T or B clone) findings, imaging (thoracic and abdominal computed tomography scan; or chest X-ray and abdominal ultrasound tomography) and bone marrow histology (for B-cell cutaneous lymphomas only).

RESULTS

In cutaneous T-cell lymphomas (n=63 including 47 mycosis fongoides), imaging revealed deep lymph nodes in 4 cases, a carcinoma of the kidney in one case, and a benign tumour in 6 cases. A T-cell clone was detected in the skin in 19/33 cases and in peripheral blood in 17/31 cases. In cutaneous B-cell lymphomas (n=23), imaging showed splenomegaly in 2 cases, a B-cell clone was detected in 3/12 cases in the skin, and bone marrow histology was normal in 21/22 cases. Among patients with cutaneous T-cell lymphomas, 14/63 (22 p. 100) had an associated malignancy. In 8/14 cases, the diagnosis of the associated malignancy was made prior to that of the cutaneous T-cell lymphoma. In 4 cases, the interval between the previous malignancy and the diagnosis of lymphoma was <or=2 Years, and in 2 other cases the malignancy was discovered on the occasion of the staging of the T-cell cutaneous lymphoma.

CONCLUSION

Laboratory investigations in cutaneous lymphomas are necessary to research deep lymph nodes, especially in case of high stage T-cell lymphomas. In exceptional cases they can reveal an associated malignancy, which is usually detected by clinical examination. In cutaneous B-cell lymphoma, bone marrow histology or cytology is generally normal hence may not be justified in low grade or localized cutaneous B-cell lymphomas.

Epidemiology of melanoma and nonmelanoma skin cancer

OBJECTIVES

To describe the epidemiology of melanoma and nonmelanoma skin cancers.

DATA SOURCES

Review and research articles, book chapters, and Surveillance, Epidemiology, and End Results (SEER) data.

CONCLUSIONS

In 2002, an estimated 1.3 million Americans were diagnosed with skin cancer. Of these, 53,000 individuals were diagnosed with melanoma, the most common fatal form of skin cancer, and more than 7,000 Americans died of melanoma. Nonmelanoma skin cancer has the highest incidence of all cancers and the rise in the rate of cutaneous melanoma exceeds all other preventable cancers.

IMPLICATIONS FOR NURSING PRACTICE

Nurses can act as case-finders and as advocates and educators for prevention of overexposure to ultraviolet radiation. Nurses should ascertain possible inherited risk and monitor patients for additional primary skin cancers.

Evidence for an association between cutaneous malignant melanoma and lymphoid malignancy: a population-based retrospective cohort study in Scotland

We analysed the risk of cutaneous malignant melanoma (CM) occurring in patients following a diagnosis of non-Hodgkin's lymphoma (NHL) or chronic lymphatic leukaemia (CLL), and of NHL or CLL subsequently developing in CM survivors. Cohorts of patients with CM, NHL or CLL (index cancer) diagnosed between 1975 and 1997 were identified from the Scottish national cancer registry and followed through the registry for subsequent CM, NHL or CLL. The standardised incidence ratio (SIR) for each cancer was calculated and overall risk, risk in relation to gender and age at diagnosis of the index cancers and time from diagnosis of the index cancer to the diagnosis of the second malignancy were measured. There were 9385 CM patients, 4016 CLL patients and 13 857 NHL patients identified with an index cancer with 56 195, 14 450 and 44 999 person-years of follow-up, respectively. There was an increased risk of both CLL and NHL following a diagnosis of CM (SIR 2.3 and 1.5, respectively) and of CM following a diagnosis of CLL and NHL (SIR 2.3 and 2.1, respectively). The risk was statistically significantly increased for CLL developing in CM patients and for CM occurring in NHL survivors (P<0.05). This study supports an association between CM, CLL and NHL developing in the same patient. Immunosuppression, exposure to ultraviolet radiation and genetic factors may lead to a host environment that is conducive to the development of these malignancies.