Melanoma recurrence after 10 years more common than once thought

Late melanoma recurrence is not rare, happens more frequently in certain clinical groups, and is associated with improved postrecurrence survival, indicates a recent study.

Although melanoma recurrence 10 years or more after initial treatment is known to occur, it has been considered to be very unlikely. However, most studies do not follow patients for longer than 10 years, pointed out Mark B. Faries, MD, a surgeon at the John Wayne Cancer Institute at Saint John's Health Center in Santa Monica, California, in a statement from the American College of Surgeons (ACS).

To explore the frequency of late-recurring melanoma, Faries and fellow researchers examined data from 4,731 persons who had received a diagnosis of skin melanoma and who had undergone long-term follow-up at John Wayne.

As Faries and colleagues reported in the ACS's Journal of the American College of Surgeons (2013;217[1]:27-34), a total of 408 patients (8.6%) experienced a melanoma recurrence after being disease-free for at least a decade (mean 15.7 years). This percentage dropped to 6.9% when including only the 327 patients with recurrence who had received their initial treatment at John Wayne.

Among those with no recurrence at 10 years, recurrence rates using actuarial analysis were 6.8% at 15 years and 11.3% at 20 years.

Compared with patients who experienced early recurrence (recurrence within 3 years after initial treatment), those who had recurrence more than 10 years later were typically younger at initial diagnosis and generally exhibited less serious characteristics of the original tumor. In addition, late recurrence was less male-predominant: Although 66% of 3,127 patients with early recurrence were male, only 57% of the 408 patients with late recurrence were male.

Late recurrence also was associated with tumor characteristics (thin, nonulcerated, non-head/neck, node-negative). Late recurrences, which were more likely to be distant, but were associated with better postrecurrence survival. Patients experiencing late recurrence were approximately 40% less likely to die of melanoma than were patients with early recurrence. Overall survival also was better in the late-recurrence group.

In the ACS statement, Faries recommended lifelong follow-up for survivors of melanoma. Even in the absence of symptoms, patients should have an annual clinical examination with their melanoma physician or a primary care physician. Faries noted that he also orders annual chest radiography and laboratory tests for his own patients with melanoma.

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