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Study Identifies Factors Associated with Increased Risk for Melanoma Among Survivors of Non-Hodgkin Lymphoma

Aug 04, 2015

Oncologists and researchers have known for years that survivors of non-Hodgkin lymphoma (NHL) have an increased risk of developing melanoma. However, the reasons for the increased risk were not well understood. Now, for the first time, a study has identified two factors associated with the increased risk of melanoma in survivors of NHL who are 65 years and older. The study was published in the Journal of Clinical Oncology (JCO), online, ahead of print, August 2nd.

The study, “Risk Factors for Melanoma Among Survivors of Non-Hodgkin Lymphoma,” found that survivors of chronic lymphocytic leukemia and small lymphocytic lymphoma (CLL/SLL) who were treated with the chemotherapy fludarabine had around a two-fold increased risk of developing melanoma compared with survivors who did not receive that treatment. In addition, the study found that survivors who had a history of certain autoimmune conditions such as asthma, Graves’ disease, and psoriasis, had around a two-fold risk of developing melanoma, compared with those who did not have those auto-immune conditions. The study did not find any factors associated with higher risk of melanoma among survivors of other, non-CLL/SLL subtypes of NHL.

Lindsay M. Morton, PhD, senior author on the study, explained that the study was made possible by linking cancer incidence data from the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) program with health care claims data from Medicare.

“What was exciting for us about this study was that we were able to use two large databases to try to explain the elevated risk of melanoma after NHL. SEER provided us with very detailed and high quality information on cancer diagnoses, with the patient medical history information from Medicare.”

A possible connection with immune dysfunction

The factors found to increase risk of melanoma among survivors of CLL/SLL—treatment with fludarabine and autoimmune conditions—are both known to disrupt immune function, particularly affecting T-cells more than B-cells. This finding is in line with previous hypotheses that  T-cell dysfunction may be a cause of the increased risk of melanoma among survivors of NHL.

“What makes this paper so intriguing is that it fits in with lines of observation from other research studies,” said Dr. Morton. “It’s that feeling of excitement when two pieces of a puzzle fit together well.”

Knowing who is at risk for melanoma lays the groundwork for prevention

Dr. Morton explained how the study’s findings can help identify patients who may need to be extra vigilant about sun protection, which is important for decreasing risk of melanoma in general, and about getting regular full body skin examinations to detect melanoma.

“This study suggests that survivors of NHL who are 65 and older, especially those who were treated with fludarabine and/or have certain autoimmune diseases might benefit most from regular, full body skin examinations, which would maximize the opportunity for early detection of melanoma.”

Looking ahead, Dr. Morton emphasized the importance of studying the risk factors for melanoma in patients younger than 65.

“Our study was restricted to the population that is eligible for Medicare [people aged 65 and older],” said Dr. Morton, “so it’s important to look at these same risk factors in younger populations.”


Lindsay M. Morton, PhD, is an investigator at the National Cancer Institute in the Division of Cancer Epidemiology and Genetics. She has been an ASCO member since 2015.

Abstract of the original JCO article.

PDF of the original JCO article.

Lam CJK, Curtis RE, Dores GM, et al. Risk factors for melanoma among survivors of non-Hodgkin lymphoma. J Clin Oncol. Epub 2015 August 2.


The Exclusive Coverage series on ASCO.org highlights selected research from JCO and JOP with additional perspective provided by the lead or corresponding author.

@ 2014 American Society of Clinical Oncology

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