This patient presented with a 0.46 mm melanoma on the neck.

A complete skin exam showed a 0.78 mm melanoma on the back. (Note the bit of a halo--halo melanoma)

MELANOMA, MULTIPLE PRIMARIES

Multiple primary melanomas [MPM] may occur in the same individual. Some studies suggest up to 10% of patients diagnosed with melanoma will develop at least one more primary melanoma in their lifetime. For some, MPM are diagnosed at the first visit.

• Just because a patient has one melanoma doesn't mean s/he can't have a second. Make sure to do a complete skin exam.
• Remember to check the vitamin D level as patients diagnosed with melanoma are more likely to be vitamin D deficient than age-matched controls.
  
• Germline mutations such as the tumor suppressor gene DCKN2A are found in about 10% of MPM cases. A family history of melanoma, MPM, early age of onset and pancreatic cancer are all factors that predict the presence of DCKN2A mutation.
  
• A similar survival risk was found for patients with MPM compared with patients with a single melanoma

RegionalDerm

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