Risk factors related to late metastases in 1,372 melanoma patients disease free more than 10 years

Abstract

In many centers, Stage I-II melanoma patients are considered "cured" after 10 years of disease-free survival and follow-up visits are interrupted. However, melanoma may relapse also later. We retrospectively analyzed a cohort of 1,372 Stage I-II melanoma patients who were disease-free 10 years after diagnosis. The aim of this study was to characterize patients who experienced a late recurrence and to compare them to those who remained disease-free to identify possible predictive factors. Multivariate Cox proportional-hazards regression analyses were carried out to evaluate the influence of different factors on the risk of recurrence. Seventy-seven patients out of 1,372 (5.6%) relapsed, 52 in regional sites and 25 in distant ones. The majority of patients (31 out of 52) experienced late recurrence in regional lymph nodes. Brain and lung were the most common site of single distant recurrence (24% each). Patients with multiple distant metastases showed a brain and lung involvement in, respectively, 40 and 48% of cases. A Cox proportional-hazards regression model analysis showed the independent role of age under 40 years, Breslow thickness >2 mm, and Clark Level IV/V in increasing the risk of Late Recurrence. These patients should be followed-up for longer than 10 years. The pattern of recurrence suggests that melanoma cells can be dormant preferentially in lymph nodes, brain and lung. A particular attention should be reserved to these anatomic sites during the follow-up after 10 years of disease-free.

Management of melanoma metastases in the brain

“…Melanoma patients in stage I and II are less likely to develop metastases in the CNS than patients in stage III and IV patients [8]. In younger patients the risk of late metastases in CNS in case of thicker primary lesions is higher [9]. Based on data from retrospective analysis carried out in a large multi-centre S0008 study, the risk of metastases in the CNS in patients with melanoma at the stage of IIIB and IIIC is 15% -they were found mainly during the first 3 years after surgery [10].…”

Surgical margins in the veterinary cancer patient

“…Dormant cancer cells might explain the phenomenon of recurrence following periods of long remission . As a stable, non‐proliferative state, dormancy is functionally different from senescence which is irreversible .…”

Biology, Therapy and Implications of Tumor Exosomes in the Progression of Melanoma

“…If detected early, primary melanoma tumors are surgically removed, resulting in a five-year survival rate of 92% and a ten-year survival rate of 89% [3]. In late stage melanoma cases that have metastasized, the one-year survival rate drops to 35%–62% [4], with the most common sites of metastasis being the lungs and the brain [5]. …”