The influence of surgical margins and prognostic factors predicting the risk of local recurrence in 3445 patients with primary cutaneous melanoma

Abstract

Risk factors associated with local recurrences were analyzed from a series of 3445 clinical Stage I melanoma patients. In single‐factor analysis, tumor thickness, ulceration, and increasing age were highly significantly predictive of recurrence (p < 0.00001). After 5 years of follow‐up, local recurrence rates were 0.2% for tumors less than 0.76 mm thick, 2.1% for tumors 0.76 to 1.49 mm thick, 6.4% for tumors 1.5 to 3.99 mm thick, and 13.2% for tumors 4.0 mm or greater in thickness. Ulcerated melanomas recurred more often than nonulcerated lesions (11.5% versus 1.9%). When analyzed as a continuous variable, increasing age increased the risk of local failure. In multifactorial analysis, all of these three factors remained independently predictive of local recurrence. Recurrences were more common with nodular melanomas (5.6%) compared to superficial spreading (2.5%) or lentigo maligna melanoma (2.5%), but this difference did not reach statistical significance (P = 0.115). Lower extremity (4.7%) and head and neck lesions (4.4%) recurred more frequently than upper extremity (1.6%) or trunk (1.2%) melanomas (P = 0.0217). The highest recurrence rates were observed in patients with melanomas located on the foot (11.6%) and hand (11.1%). The safety of conservative margins for the excision of low‐risk melanomas was demonstrated in a review of 1151 consecutive patients with melanomas less than 1 mm thick where only one local recurrence was observed. Sixty‐two percent of these patients had resection margins of 2 cm or less. In 95 patients local recurrence developed as the first site of relapse and were treated with surgical excision. The median survival for this group was 3 years, whereas 20% of this group survived 10 years. These data demonstrate that: (1) the risk of local recurrence rises with increasing tumor thickness, presence of ulceration, and age; (2) melanomas less than 1 mm thick have a very low local recurrence rate, even when excised with margins of 2 cm or less; and (3) local recurrence is a poor prognostic sign because regional and systemic metastases subsequently develop in many patients. Cancer 55:1398‐1402, 1985.

Various dermatoses what the patients with cutaneous melanoma had anxiety for the recurrence during postoperative surveillance

“…A total of 7 subsequent CMs comprised 5 local recurrences (including satellite metastases and in-transit melanoma metastases), 1 distant metastasis, and 1 second primary melanoma. The incidence of local recurrence was 3.1%; this was consistent with previous studies that reported a local recurrence rate of approximately 3%∼5% [13][14][15] . The prevalence of a second primary melanoma following a primary CM was 0.6%; this was similar than the prevalence of 0.5%∼5.5% reported by previous studies [16][17][18][19] .…”

The history of dermatology, venereology and dermatopathology in different countries - Argentina

“…In these statistics, the term "recurrence" may indicate local recurrence, regional metastasis, and/or distant metastasis or all of these. The incidence of local recurrence is estimated to be 3-5% in some studies [2,12,13]. and these recurrences usually present within 5 years after diagnosis of the primary melanoma [14].…”

“…However, unlike the current case, none of these patients experienced local recurrences in the same site more than once. Studies and reviews of local recurrence by Urist, Cohn-Cedermark, Dong, and Heenan did not include late recurrences [2,13,15,16]. Another study by Crowley, et al, reported 18 patients with local recurrence after at least 10 years of disease free interval, but the follow up information on local recurrence was grouped with regional node and in-transit recurrence and thus this data was excluded from our review [17].…”

“…Several studies concur that a longer disease free interval is a predictor of superior survival for patients with local recurrence [15,17,19,27]. The reported five year survival of patients with local recurrence varies from 34% [13] up to 80% [1]; although prognostic data of late local recurrence has not been separated out from overall local recurrence in prior studies, our review suggests that the survival statistics may be similar for both groups. Including our case, final outcome was reported in 16 patients with late local recurrence.…”

Subcutaneous malignant melanoma of the scalp surgical flap after brain irradiation for anaplastic astrocytoma

“…It is the sign of aggressive biology that leads to distant metastatic disease and implies a poor prognosis in over 80% of cases [43]. The head-neck region, in particular, is associated with a greater risk of local recurrence, and a worse prognosis [44].…”