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Prognosis and Determinants of Outcome Following Locoregional or Distant Recurrence in Patients with Cutaneous Melanoma

  • Melanomas
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Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Objective

Information on prognosis for patients with cutaneous melanoma after locoregional or distant recurrence is sparse and controversial. The aim of this study was to analyze factors influencing outcome after the development of a first relapse.

Methods

Information was extracted from the Sydney Melanoma Unit database for 873 melanoma patients with American Joint Committee on Cancer (AJCC) Stage I and II disease treated between 1960 and 2002 who relapsed following treatment of their primary melanoma. Clinical and pathologic factors predicting survival were analyzed using the Cox proportional hazards regression model.

Results

Initial presentation of recurrence was local: 95 patients (10.9%), in transit: 86 patients (9.9%), regional lymph node: 300 patients (34.4%), and distant: 392 patients (44.9%). Independent prognostic factors for survival of the 481 patients with only locoregional recurrence were type of recurrence, primary tumor ulceration, and patient age. Predictors for longer survival in the 392 patients with distant metastasis at the time of first presentation with recurrence were lung vs other sites and diagnosis of relapse after 1990 compared with diagnosis before 1980.

Conclusions

The type of recurrence is the most important prognostic factor in melanoma patients who relapse. Primary tumor ulceration is the most important pathologic predictor. The results of this study suggest that management of distant metastases may have improved over the last 25 years, but many confounders and improved staging techniques make assessment of this unreliable.

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Acknowledgments

Anne Brecht Francken was a Sydney Melanoma Unit and Groningen University Medical Center Research Fellow supported by: Stichting VSB Fonds, Stichting Dr Hendrik Muller’s Vaderlandsch Fonds, Stichting Fonds Doctor, Catherine van Tussenbroek- Nell Ongerboer Fonds, Stichting Groninger Universiteits Fonds, Stichting De Korintiers, Nederlandse Kankerbestrijding—Koningin Wilhemina Fonds, Marco Polo Fonds, The Melanoma Foundation of the University of Sydney, Integraal Kankercentrum Noord-Nederland.

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Authors and Affiliations

  1. Sydney Melanoma Unit, Sydney Cancer Centre, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia

    Anne Brecht Francken MD, Helen M. Shaw PhD, Martin Wiener MBChB & John F. Thompson MD, FRACS, FACS

  2. Division of Surgical Oncology, Groningen University Medical Center and University of Groningen, Groningen, The Netherlands

    Anne Brecht Francken MD & Harald J. Hoekstra MD, PhD

  3. Biostatistics and Bioinformatics Unit, Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama, USA

    Neil A. Accortt PhD & Seng-jaw Soong PhD

  4. Discipline of Surgery, The University of Sydney, Sydney, New South Wales, Australia

    Helen M. Shaw PhD & John F. Thompson MD, FRACS, FACS

Authors
  1. Anne Brecht Francken MD
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  2. Neil A. Accortt PhD
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  3. Helen M. Shaw PhD
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  4. Martin Wiener MBChB
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  5. Seng-jaw Soong PhD
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  6. Harald J. Hoekstra MD, PhD
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  7. John F. Thompson MD, FRACS, FACS
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Corresponding author

Correspondence to John F. Thompson MD, FRACS, FACS.

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Francken, A.B., Accortt, N.A., Shaw, H.M. et al. Prognosis and Determinants of Outcome Following Locoregional or Distant Recurrence in Patients with Cutaneous Melanoma. Ann Surg Oncol 15, 1476–1484 (2008). https://doi.org/10.1245/s10434-007-9717-9

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  • DOI: https://doi.org/10.1245/s10434-007-9717-9

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