Childhood cancer survivors undergo increased risk of melanoma: ASCO Study

A new study published in the Journal of Clinical Oncology found that childhood cancer survivors have a more than twofold increased risk of developing melanoma when compared to the general population.

Although it has long been recognized that children who have survived cancer are more likely to develop melanoma than the general population, the pertinent risk factors for melanoma have not yet been identified. Due to a lack of big enough patient populations and detailed data, doctors had long hypothesized a possible link between therapeutic radiation and melanoma, but this had never been confirmed. Thus, to determine the incidence of melanoma in pediatric cancer survivors, Seth Rotz and team carried out this investigation.

The Childhood Cancer Survivor Study cohort's melanoma incidence, risk factors, and outcomes were evaluated by this study. Hazard ratios (HRs) and related 95% CI for melanoma risk variables were determined using multivariable Cox models, and cumulative incidence and standardized incidence ratios (SIRs) were computed. The Cox model was modified to include radiation exposure to seven body locations and the presence of melanoma in each of the eight regions per survivor.

A total of 177 melanomas (110 invasive, 62 in situ cutaneous, and five ocular) was observed in 160 survivors out of 25,716 developed. The cumulative incidence of melanoma during a 40-year period was 1.1% for all individuals and 1.5% for those who received ≥40 Gy of cumulative radiation. For invasive cutaneous or ocular melanoma, the SIR was 2.0 when compared to the general population.

Increased cutaneous melanoma was linked to bleomycin exposure, which is a cumulative cyclophosphamide equivalent dose of ≥20,000 mg/m2, and a cumulative radiation dosage of ≥40 Gy to the relevant body region(s) of the melanoma. Any type of invasive melanoma was linked to a higher chance of mortality.

Overall, it should be possible to determine whether people are at higher risk clinically now that the risk variables are understood. It is necessary to ascertain whether certain screening methods (such as a yearly skin examination by a dermatologist) can assist in identifying melanoma in these people earlier and whether doing so can eventually stop advanced melanoma or even mortality. Future patient education and screening should take into account the significant risk factors for melanoma, which include exposure to high doses of radiation, alkylating agents, and bleomycin.

Source:

Rotz, S. J., Stratton, K., Leisenring, W. M., Smith, S. A., Howell, R. M., Bates, J. E., Pappo, A. S., Neglia, J. P., Armstrong, G. T., & Turcotte, L. M. (2025). Melanoma among adult survivors of childhood cancer: A report from the Childhood Cancer Survivor Study. Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology. https://doi.org/10.1200/jco-24-01519