Background: The diagnosis of primary melanoma increases the risk of additional primary melanomas. Objective: We characterize the subgroup of patients with multiple melanomas. Methods: We reviewed the melanoma database. Results: Sixty patients with multiple primary melanomas were identified. Twelve (20%) experienced melanomas in the same regional location, 43 (72%) in different locations, and 5 (8%) in both the same and different locations (> 2 melanomas). Eighteen (30%) were diagnosed concurrently with multiple melanomas, 38 (63%) subsequently, and 4 (7%) concurrently and subsequently (>2 melanomas). Forty-two percent of subsequent melanomas occurred within 3 years of the initial lesion diagnosis, 9 (17%) between 3 and 7 years, and 22 (42%) after more than 7 years. Subsequent melanomas were thinner in 70% of cases (P = .05). The mean age at first melanoma diagnosis was 38 and 59 years, respectively, for those with and without dysplastic nevi (P < .001). Conclusion: In patients with multiple melanomas, subsequent melanomas often occur in different regional locations several years after diagnosis of the initial lesion. (J Am Acad Dermatol 1998;39:422-7.)