Analysis of prognosis and disease progression after local recurrence of melanoma

Abstract

BACKGROUND Local recurrence of melanoma is associated with a grave prognosis. However, the characteristics and the mode of disease progression for patients with local recurrence have not been adequately addressed in the literature. METHODS A retrospective analysis of patients treated at a single institution revealed a subset of patients (n = 648) with local recurrence of melanoma as a first event. Patient characteristics, histologic determinants, and disease free interval were variables used to identify prognostic factors. RESULTS In this group of patients, male gender (P = 0.0163), increasing age (P = 0.0001), head and neck primaries (P = 0.0001), thicker Breslow depths (P = 0.0022), deeper Clark levels (P = 0.0010), and ulceration of the primary tumor (P = 0.0348) suggested a shorter time until local recurrence. Breslow depth (P = 0.0004), Clark level (P = 0.0043), and ulceration (P = 0.0001) still factored into the survival prognosis after recurrence. Truncal primaries (P = 0.0005) and shorter disease free intervals (P = 0.0098) were also associated with poorer outcomes after recurrence. Of the 648 patients, 124 showed no progression, 196 developed another local recurrence, 178 developed in‐transit/lymph node metastases, and 150 had systemic recurrences. Survival was only 33.6% for patients with further metastases, compared with 77.4% for patients with no progression of disease after a median follow‐up of 38.9 months. CONCLUSIONS There was a 48.5% mortality rate at 5 years of follow‐up after local recurrence. Long term survival (> 10 years) was estimated to be 34.9%. The patterns of failure after local recurrence suggest that patients may benefit from aggressive locoregional therapy. Cancer 2000;88:1063–71. © 2000 American Cancer Society.

Isolated Limb Perfusion for Malignant Melanoma: Systematic Review on Effectiveness and Safety

“…Again, no direct comparison with the recurrence rate of other therapeutic alternatives was possible. However, even after surgical resection of in-transit melanoma metastases, further locoregional recurrences were described in up to 58% of patients [50].…”

Malignant Melanoma S3‐Guideline “Diagnosis, Therapy and Follow‐up of Melanoma”

“…Here, one has to differentiate between metastatic pathways of the lymphatic drainage area (satellite metastases, in-transit metastases, subcutaneous metastases) and lymph node metastases as a result of lymph vessel invasion. Solitary cutaneous or subcutaneous metastases should be completely (clear surgical margins) resected, if tumor clearance is thus attainable [77]. This applies to R1 as well as R2 situations.…”

Mayo Clinic Consensus Recommendations for the Depth of Excision in Primary Cutaneous Melanoma

“…Most local recurrences occur within the first few years after diagnosis but some have been reported as long as 15 years or more later. 11 Local recurrence is most likely a manifestation of residual microsatellites in the neighboring tissue left behind after resection. 12 In contrast to local recurrences of basal or squamous cell carcinomas that are not lifethreatening, a local recurrence of melanoma is associated with a very poor overall survival rate.…”

“…More aggressive tumor features, including thick primary tumor, ulceration, lymphovascular invasion, location of the primary melanoma, lymph node involvement, desmoplastic subtype, and satellitosis have all been shown to be significant risk factors for locoregional recurrence. 11,[13][14][15] Although the presence of dermal lymphatic invasion is an infrequent finding, a review article noted that it was present in most patients who experienced a local recurrence. 13 The incidence of lymphovascular invasion is approximately 5% and closely mirrors the 3% to 7% incidence of local recurrence in patients with melanoma.…”

“…14,20,21 Most of these patients subsequently develop additional local, lymph node, or distant metastases, each associated with declining 5-year survival (45.4%, 34.3%, and 17.3%, respectively). 11 In some cases of local recurrence, operative resection can result in prolonged survival; however, local recurrence is frequently associated with distant systemic disease.…”