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Analysis of prognosis and disease progression after local recurrence of melanoma
Author(s) -
Dong Xiang D.,
Tyler Douglas,
Johnson Jeffrey L.,
DeMatos Pierre,
Seigler Hilliard F.
Publication year - 2000
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/(sici)1097-0142(20000301)88:5<1063::aid-cncr17>3.0.co;2-e
Subject(s) - medicine , breslow thickness , melanoma , disease , retrospective cohort study , confidence interval , surgery , lymph node , survival analysis , gastroenterology , oncology , cancer , sentinel lymph node , cancer research , breast cancer
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.