Beyond survival: the risk of subsequent primary melanoma in childhood cancer survivors

In this issue of the Journal, Shojaie and colleagues1 report long-term risks of subsequent primary melanoma in a large cohort of 68 002 five-year childhood cancer survivors across 12 European countries. Survivors were 2.3 times more likely to develop subsequent primary melanoma compared with the general population. Although the standardized incidence ratios (SIRs) decreased as survivors age, the absolute excess risks continued to rise, peaking after age 50 years—a period for which this study provides important new estimates. Risk was highly heterogeneous across subgroups. Survivors of heritable retinoblastoma experienced a 16.5-fold increased risk and a 5.5% cumulative incidence by age 60 years, while those who received radiotherapy had a 4-fold increased risk after age 50 years. These findings highlight that cancer type and attained age are important determinants of subsequent primary melanoma risk. Importantly, the study underscores that survivorship care requires a lifelong perspective that accounts for changes in absolute risk with age. The authors also advocate for enhanced dermatologic surveillance in high-risk groups to facilitate early detection, as well as general melanoma risk-reduction strategies for all survivors, including skin self-examination and sun protection. The PanCareSurFup study has several key strengths, notably its unprecedented scale, long-term follow-up, and ability to evaluate rare outcomes across diverse subgroups. It represents the largest assembled cohort of childhood cancer survivors worldwide, including 68 002 individuals from 12 European countries and data contributions from 11 population-based cancer registries. This scale provides the statistical power needed to analyze rare outcomes and specific subgroups. The cohort spans a long period, including survivors diagnosed between 1940 and 2008, and contributes more than 1.2 million person-years of follow-up, enabling robust assessment of late effects that may take decades to emerge. Loss to follow-up was low (