Do individuals with malignant melanoma have a higher risk of later developing Chronic Lymphocytic Leukemia (CLL) and Non-Hodgkin's Lymphoma (NHL)?

From the Guidelines

People with malignant melanoma are at a higher risk of later developing chronic lymphocytic leukemia (CLL) and non-Hodgkin lymphoma (NHL), although the provided evidence does not directly support this association. The connection between these malignancies is likely bidirectional, involving shared genetic susceptibilities, immune system dysregulation, and similar environmental risk factors such as ultraviolet radiation exposure 1. However, the most recent and highest quality study provided, which is the 2019 ESMO clinical practice guidelines for diagnosis, treatment, and follow-up of cutaneous melanoma, does not specifically address the risk of developing CLL or NHL in melanoma patients 1.

Key Points to Consider

• The 2019 ESMO guidelines focus on the follow-up and long-term implications of melanoma, emphasizing the importance of monitoring for secondary skin tumors and recognizing additional skin tumors, especially secondary melanomas, as early as possible 1.
• The guidelines also mention that melanoma patients have an increased risk for other skin tumors, with 35% of patients with lentigo maligna melanoma (LMM) developing another cutaneous malignancy within 5 years 1.
• While the guidelines do not provide direct evidence for the association between melanoma and CLL or NHL, they highlight the need for long-term follow-up care and monitoring for symptoms of secondary malignancies.

Implications for Clinical Practice

• Healthcare providers should maintain vigilance for potential secondary malignancies, including hematologic malignancies, when caring for melanoma patients, particularly in the years following diagnosis and treatment.
• Long-term follow-up care should include monitoring for symptoms of hematologic malignancies, such as unexplained fatigue, enlarged lymph nodes, night sweats, and frequent infections.
• The lack of direct evidence in the provided studies underscores the need for further research into the association between melanoma and CLL or NHL, as well as the importance of considering individual patient risk factors and needs when developing follow-up care plans 1, 2.

From the Research

Relationship Between Malignant Melanoma and Later Development of CLL and NHL

• There is limited direct evidence to suggest that people with malignant melanoma are at a higher risk of later developing Chronic Lymphocytic Leukemia (CLL) and Non-Hodgkin's Lymphoma (NHL) based on the provided studies 3, 4, 5, 6, 7.
• However, one study suggests that CLL is associated with immune dysfunction and an increased risk of melanoma 7.
• Another study discusses the treatment of CLL, including targeted therapies and chemoimmunotherapy, but does not provide information on the relationship between malignant melanoma and the development of CLL or NHL 4, 5.
• A study on metastatic melanoma discusses the development of resistance to chemotherapy and molecularly targeted therapies, but does not address the risk of developing CLL or NHL 6.
• One case series study found that checkpoint blockade therapy showed clinical activity in patients with melanoma and concomitant CLL, but did not provide evidence that CLL responded to the checkpoint blockade 7.

Key Findings

• CLL is associated with immune dysfunction and an increased risk of melanoma 7.
• Checkpoint blockade therapy can be effective in patients with melanoma and concomitant CLL, but may require closer surveillance for hematologic immune-related toxicities 7.
• There is a need for further study to understand the relationship between malignant melanoma and the development of CLL and NHL, as the current evidence is limited 3, 4, 5, 6, 7.