{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T08:28:13Z","timestamp":1787128093755,"version":"build-2736575974"},"reference-count":29,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T00:00:00Z","timestamp":1787097600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Iuliu Hatieganu University of Medicine and Pharmacy"},{"id":[{"id":"https:\/\/ror.org\/051h0cw83","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Med. Sci.","Medical Sciences"],"abstract":"<jats:p>Background and objectives: Melanoma survivors may develop additional primary malignancies, but data from Eastern European hospital cohorts are scarce. We aimed to estimate the observed incidence of second primary cancers (SPCs) within a Romanian referral-centre cohort, identify associated factors, and explore the association of SPC occurrence with overall survival. Methods: We conducted a retrospective, hospital-based cohort study of 394 patients with histopathologically confirmed cutaneous melanoma followed at two referral centres in Cluj-Napoca. Additional malignancies were counted as new primaries only when clinical and\/or histopathological documentation distinguished them from recurrence or metastasis. Incidence density was expressed per 1000 person-years. Multivariable logistic regression assessed age, sex, residence, and Breslow thickness. Fixed-covariate Cox and Kaplan\u2013Meier analyses were considered exploratory because of immortal-time and competing-risk limitations. Results: Over 1848 person-years, 79 patients (20.1%) developed at least one SPC (131 events; observed incidence 70.9\/1000 person-years), most frequently cutaneous (53.6\/1000 person-years). SPC occurrence increased with age (Cochran\u2013Armitage Z = 5.63, p &lt; 0.001); the Kaplan\u2013Meier complement estimate reached 20.7% at five years. Age independently predicted SPC (OR 1.86 per decade, p &lt; 0.001), whereas greater Breslow thickness was inversely associated (OR 0.86, p = 0.008). Actinic keratosis showed a strong unadjusted association (OR 6.64, p &lt; 0.001) but was not included in the adjusted model. The fixed-status Cox model showed lower mortality among patients with an SPC (HR 0.36, p &lt; 0.001), a finding vulnerable to detection and immortal-time bias. Conclusions: SPCs were frequent in this hospital cohort and predominantly cutaneous. Older age was an independent predictor, while actinic keratosis was a strong unadjusted marker. Prospective, population-based validation is needed before surveillance intensity is individualised.<\/jats:p>","DOI":"10.3390\/medsci14040494","type":"journal-article","created":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T07:58:23Z","timestamp":1787126303000},"page":"494","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Risk of Second Primary Cancers in Melanoma Survivors: A Retrospective Hospital-Based Cohort Study from Two Romanian Referral Centres"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-4990-6217","authenticated-orcid":false,"given":"Salomea-Ruth","family":"Halm\u00e1gyi","sequence":"first","affiliation":[{"name":"Department of Dermatology, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8535-9677","authenticated-orcid":false,"given":"Loredana","family":"Ungureanu","sequence":"additional","affiliation":[{"name":"Department of Dermatology, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania"},{"name":"Department of Dermatology, Emergency County Hospital, 400006 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alina Florentina","family":"Vasilovici","sequence":"additional","affiliation":[{"name":"Department of Dermatology, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania"},{"name":"Department of Dermatology, Emergency County Hospital, 400006 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mihail-Alexandru","family":"Badea","sequence":"additional","affiliation":[{"name":"Dermatology Department, The George Emil Palade University of Medicine, Pharmacy, Science, and Technology, 540139 Targu Mures, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ioana-Irina","family":"Trufin","sequence":"additional","affiliation":[{"name":"Department of Dermatology, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adina Patricia","family":"Apostu","sequence":"additional","affiliation":[{"name":"Department of Dermatology, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-4373-7296","authenticated-orcid":false,"given":"Adrian Ilie","family":"Pascu","sequence":"additional","affiliation":[{"name":"Department of Dermatology, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simona Corina","family":"\u015eenila","sequence":"additional","affiliation":[{"name":"Department of Dermatology, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania"},{"name":"Department of Dermatology, Emergency County Hospital, 400006 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1016\/j.jaad.2024.09.035","article-title":"Global trends in melanoma burden: A comprehensive analysis from the Global Burden of Disease Study, 1990\u20132021","volume":"92","author":"Sun","year":"2025","journal-title":"J. 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