Melanoma among adult survivors of childhood cancer in the Childhood Cancer Survivor Study

Analysis among 25,716 adult survivors in the Childhood Cancer Survivor Study found that 177 melanomas developed in 160 survivors (110 invasive, 62 in situ, five ocular).The 40-year cumulative incidence was 1.1% (95% CI 0.9-1,4) among all participants and 1.5% (1.0-2.1) among those receiving a cumulative radiation dose of ≥ 40 Gy. Compared with the general population, the standardized incidence ratio for skin or ocular melanoma was 2.0 (95% CI 1.6-2.4). Factors associated with increased cutaneous melanoma were cumulative radiation dose of ≥ 40 Gy to the corresponding body region(s) of the melanoma, cumulative cyclophosphamide equivalent dose of ≥ 20,000 mg/m², and bleomycin exposure. Invasive melanoma at any site was associated with and increased risk of death (HR 2.4; 95% CI 1,7-3.3). The authors conclude that childhood cancer survivors have more than a two-fold increased risk of melanoma compared with the general population, and those with invasive melanoma have more than a two-fold risk of death.