Late Recurrence in Melanoma: Clinical Implications of Lost Dormancy

Abstract

Background For patients with melanoma, if there has been no recurrence of disease 10 years after initial treatment, additional disease is felt to be very unlikely. However, such late recurrence are known to occur. The frequency of this phenomenon and its clinical significance are not well characterized due to the difficulty in obtaining relevant data. We examined a large, mature, institutional database to evaluate late recurrence. Study Design The late recurrence cohort was defined as having a DFI of ≥10 years after potentially curative treatment and was compared to an early recurrence cohort recurring within 3 years. Actuarial late recurrence frequency and factors associated with late recurrence were examined. Post-recurrence overall and melanoma-specific survival and prognostic variables were analyzed. Results Among all patients, 408 exhibited late recurrence (mean DFI 15.7 years). For patients who received primary treatment at our institution with ≥10 years follow-up, 327/4731 (6.9%) showed late recurrence. On an actuarial basis, late recurrence rates were 6.8% and 11.3% at 15 and 20 years respectively for those with no recurrence at 10 years. Late recurrence was associated with both tumor (thin, non-ulcerated, non-head/neck, node negative) and patient (younger age, less male predominant) characteristics. Multivariate analysis confirmed younger age, thinner and node negative tumors in the late recurrence group. Late recurrences were more likely to be distant, but were associated with better post-recurrence survival on univariate and multivariate analyses. Conclusions Late melanoma recurrence is not rare. It occurs more frequently in certain clinical groups and is associated with improved post-recurrence survival.

Final Trial Report of Sentinel-Node Biopsy versus Nodal Observation in Melanoma

“…Any remaining differences in the frequency of nodal metastasis may be accounted for by chance or by late nodal recurrences still pending in the observation group. 31,32 These data indicate that essentially all metastases detected by sentinel-node biopsy eventually would have become clinically evident if not removed.…”

Clinicopathological Features of Early and Late Recurrence of Endometrial Carcinoma After Surgical Resection

“…8 Conversely, in patients with nonYsmall cell lung cancer, 10.6% (87/819) of the patients with no recurrence at 5 years after diagnosis subsequently developed recurrence. 9 Yet, in another study, late recurrence beyond 10 years was observed in 327 (6.9%) of 4731 patients, 10 whereas recurrence beyond 5 years for colorectal cancer was reported in 36 (0.89%) of 4023 cases. 11 In the current study, the rate of recurrence beyond 5 years after curative surgery was 1.0%.…”

Gender-Based Differences and Barriers in Skin Protection Behaviors in Melanoma Survivors

“…Patients facing late recurrence were typically younger, with an average age of 41 to an average of 51 for early recurrence of melanoma [22, 23]. Studies have shown that sunscreen use decreases the incidence of sunburns.…”