High-Risk Primary Melanomas: Risk of Recurrence
Posted: Tuesday, June 25, 2019
Patients with high-risk primary melanoma seem to be at risk for recurrence as soon as 2 years after diagnosis, and so they may benefit from sentinel lymph node biopsy. Lena A. von Schuckmann, MBBS, MPH, of QIMR Berghofer Medical Research Institute, Brisbane, Australia, and colleagues reported their findings in JAMA Dermatology.
“Head or neck location of initial tumor, [sentinel lymph node biopsy] positivity, and signs of rapid tumor growth may be associated with primary melanoma recurrence,” the authors concluded.
In this prospective cohort study, 700 Australian patients with high-risk, surgically treated, melanoma were included in analysis. Melanomas were staged according to the American Joint Committee on Cancer version 7 or 8.
Overall, 94 patients experienced at least 1 recurrence within 2 years of diagnosis. Locoregional recurrence accounted for the majority of first recurrences, occurring in 70.2% of patients; distal recurrence occurred in 29.8% of patients. The median time to first and second recurrences was 40 weeks and 57 weeks, respectively. Factors such as the presence of ulceration, more than 3/mm2 mitotic figures, advanced disease stage, or unclassified histologic subtype were associated with 2-year recurrence. Head and neck melanomas were most likely to recur, followed by tumors on the trunk or lower limbs; tumors on the upper limbs tended to be the least likely to recur.
Disease-free survival rates at 2 years were 95% and 67% for patients with T1b and T4b tumors, respectively. These rates were lower in patients with ulceration and/or absence of sentinel lymph node biopsy.
Disclosure: The study authors reported no conflicts of interest.