Patients who develop more than one cutaneous melanoma may need closer surveillance as they are at greater risk of death, a Dutch study suggests.

In what the researchers say is the largest study to date, those with multiple melanomas at diagnosis had a 31% increased risk of death over a median follow-up of 6.25 years compared with those who had only one melanoma.

The researchers analysed data for all patients diagnosed with cutaneous melanoma in the Netherlands between 2000 and 2014, a total of nearly 57,000 people.

Of these, 4% (2284 people) were found to have multiple primary melanomas, the authors reported in JAMA Dermatology.