Risk of Melanoma Recurrence After Diagnosis of a High-Risk Primary Tumor.

Risk of Melanoma Recurrence After Diagnosis of a High-Risk Primary Tumor.

Publication date: May 01, 2019

With emerging new systemic treatments for metastatic melanoma, early detection of disease recurrence is increasingly important.

To investigate the risk of melanoma recurrence in patients with a localized melanoma at a high risk of metastasis.

A total of 1254 patients with newly diagnosed, histologically confirmed tumor category T1b to T4b melanoma in Queensland, Australia, were recruited prospectively between October 1, 2010, and October 1, 2014, for participation in a cohort study. Data analysis was conducted from February 8, 2018, to February 20, 2019. We used Cox proportional hazards regression analysis to examine associations between patient and tumor factors and melanoma recurrence.

Disease-free survival (DFS) by melanoma tumor category defined by the 7th vs 8th editions of the AJCC Cancer Staging Manual (AJCC 7 vs AJCC 8).

Melanoma recurrences were self-reported through follow-up questionnaires administered every 6 months and confirmed by histologic or imaging findings.

Of 1254 patients recruited, 825 individuals (65.8%) agreed to participate. Thirty-six were found to be ineligible after providing consent and a further 89 patients were excluded after reclassifying tumors using AJCC 8, leaving 700 participants with high-risk primary melanoma (mean [SD] age, 62.2 [13.5] years; 410 [58.6%] men). Independent predictors of recurrence were head or neck site of primary tumor, ulceration, thickness, and mitotic rate greater than 3/mm2 (hazard ratio, 2.36; 95% CI, 1.19-4.71). Ninety-four patients (13.4%) developed a recurrence within 2 years of diagnosis: 66 tumors (70.2%) were locoregional, and 28 tumors (29.8%) developed at distant sites. After surgery for locoregional disease, 37 of 64 patients (57.8%) remained disease free at 2 years, 7 patients (10.9%) developed new locoregional recurrence, and 20 patients (31.3%), developed distant disease. Two-year DFS was similar when comparing AJCC 7 and AJCC 8, for T1b (AJCC 7, 253 [93.3% DFS]; AJCC 8, 242 [93.0% DFS]) and T4b (AJCC 7 and AJCC 8, 50 [68.0% DFS] category tumors in both editions. Patients with T2a to T4a tumors who did not have a sentinel lymph node biopsy (SLNB) at diagnosis had lower DFS than patients with the same tumor category and a negative SLNB (T2a: 136 [91.1%; 95% CI, 86.4-95.9] vs 96 [96.9%; 95 % CI, 93.4-100.0]; T4a: 33 [78.8%; 95% CI, 64.8-92.7] vs 6 [83.3; 95% CI, 53.5-100.0]).

These findings suggest that 13.4% of patients with a high-risk primary melanoma will experience disease recurrence within 2 years. Head or neck location of initial tumor, SLNB positivity, and signs of rapid tumor growth may be associated with primary melanoma recurrence.

von Schuckmann, L.A., Hughes, M.C.B., Ghiasvand, R., Malt, M., van der Pols, J.C., Beesley, V.L., Khosrotehrani, K., Smithers, B.M., and Green, A.C. Risk of Melanoma Recurrence After Diagnosis of a High-Risk Primary Tumor. 22490. 2019 JAMA Dermatol.

Concepts Keywords
AJCC DecisionDx-UM
Australia Lung cancer staging
Cohort Study Clinical medicine
DFS Health
Histologic Melanoma
Histologically Medicine
JAMA RTT
Melanoma Cancer staging
Metastasis Locoregional tumors
Mitotic Histologic imaging findings
Primary Tumor Surgery
Queensland
Tumor
Ulceration

Semantics

Type Source Name
disease MESH growth
gene UNIPROT PNMA2
gene UNIPROT ELL
disease MESH men
disease DOID Cancer
gene UNIPROT COX5A
gene UNIPROT COX8A
gene UNIPROT CPOX
disease MESH metastasis
disease MESH Tumor
disease MESH Diagnosis
disease MESH Recurrence
pathway BSID Melanoma
disease DOID Melanoma
disease MESH Melanoma

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