Characteristics associated with early and late melanoma metastases

Brauer, Jeremy A.; Wriston, Cooper C.; Troxel, Andrea B.; Elenitsas, Rosalie; Shin, Daniel B.; Guerry, DuPont; Ming, Michael E.

doi:10.1002/cncr.24724

Cited by 32 publications

(27 citation statements)

References 14 publications

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“…Brauer et al compared 320 early recurrence patients (<3 year DFI) to 70 LR (>8 year DFI) and found thinner, non-ulcerated lesions and a relative absence of previous non-melanoma skin cancers in the late recurrence group, but could not confirm the significance of age or sex on multivariate analysis. 7 Our analysis would seem to unify the findings of these two prior, series in that age, gender, thickness and ulceration were all independently associated with late recurrence. While older patients may be less likely to develop late melanoma recurrences due to competing mortality risks, the mean age of the even the early recurrence cohort (51 years) would suggest that these patients would be likely to live well beyond 10 years, excluding their melanoma diagnosis.…”

Section: Discussionsupporting

confidence: 56%

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Late Recurrence in Melanoma: Clinical Implications of Lost Dormancy

Faries¹,

Steen²,

Ye³

et al. 2013

Journal of the American College of Surgeons

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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.

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Section: Discussionsupporting

confidence: 56%

“…As evidenced by the wide range of frequencies reported in prior series (0.41% to 25% (Table 3)) 1,7–22 , determination of the precise number is challenging. The variability may result from small sample size, inadequate long-term follow up, or referral bias.…”

Section: Discussionmentioning

confidence: 99%

Late Recurrence in Melanoma: Clinical Implications of Lost Dormancy

Faries¹,

Steen²,

Ye³

et al. 2013

Journal of the American College of Surgeons

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“…The capacities in which the immune system can interact with melanomas are complex and can be different in different circumstances. Some authors have implicated components of the immune system such as macrophages as having a primarily pro-tumor and pro-metastasis function [250-253], while other authors have identified components of the immune system that can negatively regulate melanoma and melanoma metastasis [254]. Enhancement of immune-mediated tumor rejection is a central means by which promising new melanoma therapies function [255].…”

Section: Other Considerations In Melanoma Metastasismentioning

confidence: 99%

Decoding Melanoma Metastasis

Damsky

Rosenbaum

Bosenberg

2010

Cancers

176

138

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Metastasis accounts for the vast majority of morbidity and mortality associated with melanoma. Evidence suggests melanoma has a predilection for metastasis to particular organs. Experimental analyses have begun to shed light on the mechanisms regulating melanoma metastasis and organ specificity, but these analyses are complicated by observations of metastatic dormancy and dissemination of melanocytes that are not yet fully malignant. Additionally, tumor extrinsic factors in the microenvironment, both at the site of the primary tumor and the site of metastasis, play important roles in mediating the metastatic process. As metastasis research moves forward, paradigms explaining melanoma metastasis as a step-wise process must also reflect the temporal complexity and heterogeneity in progression of this disease. Genetic drivers of melanoma as well as extrinsic regulators of disease spread, particularly those that mediate metastasis to specific organs, must also be incorporated into newer models of melanoma metastasis.

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“…In a previous study of over 500 metastatic skin cancers, early metastasis (<3 years after surgery) was found to be significantly associated with past history of non-melanoma skin cancer, thicker lesions (Breslow depth), and ulcerative melanomas (19). In contrast, a history of non-ulcerative melanoma was found to be associated with late recurrence (>8 years after primary disease), this being consistent with our observation of tendency for orbital metastases of cutaneous melanoma to be a late phenomenon.…”

Section: Discussionmentioning

confidence: 88%

Presentation, Treatment, and Prognosis of Secondary Melanoma within the Orbit

et al. 2017

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BackgroundOcular melanoma is a rare but often deadly malignancy that arises in the uvea, conjunctiva, or orbit. Uveal melanoma is the most common type, with conjunctival melanoma being the second most frequently observed. Melanoma accounts for 5–10% of metastatic or secondary orbital malignancies, but only a minute proportion of primary orbital neoplasia. The aim of this study was to characterize the clinical presentation, treatment, and prognosis in patients presenting with melanoma metastatic to, or secondary within, the orbit.MethodsA retrospective cohort study of patients presenting to a tertiary referral orbital unit from 1982 to 2016 was performed. Eighty-nine patients with biopsy-proven diagnosis of melanoma within the orbit were included in the study. The clinical notes, radiological imaging, histology, surgical notes, and outcome data for the patients were reviewed. The main outcome measures of interest were the interval between primary malignant melanoma and orbital presentation, survival after orbital presentation, and clinical parameters (such as gender, age at presentation, and treatment approach).ResultsThe commonest primary source of tumor was choroidal melanoma, with conjunctival and cutaneous melanomas being relatively common; eyelid and naso-sinus tumors occurred in a few cases. The mean age at presentation with orbital disease was 65 years (31–97 years). The interval between primary malignancy and orbital disease (either local spread/recurrence or true metastatic disease) showed wide variability, with almost one-third of patients having orbital disease at the time of primary diagnosis, but others presenting many years later; indeed, the longest orbital disease-free interval was over 34 years. Twenty-three patients were considered to have had late orbital metastases—that is, at more than 36 months after primary tumor. The median survival following presentation with orbital involvement was 24 months. Patients with tumors of cutaneous origin had worst survival, whereas those with conjunctival tumors had the best prognosis.ConclusionA high index of suspicion for orbital recurrence should be maintained in any patient with prior history of melanoma, however distant the primary tumor is in site or time. Furthermore, giving a prognosis for orbital melanoma remains problematic due to highly variable survival, and further investigation will be necessary to understand the likely genetic basis of this phenomenon.

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Characteristics associated with early and late melanoma metastases

Cited by 32 publications

References 14 publications

Late Recurrence in Melanoma: Clinical Implications of Lost Dormancy

Late Recurrence in Melanoma: Clinical Implications of Lost Dormancy

Decoding Melanoma Metastasis

Presentation, Treatment, and Prognosis of Secondary Melanoma within the Orbit

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