More than 10% of patients with high-risk primary localized melanoma will experience either a local or distant recurrence of disease within 2 years of diagnosis. The findings from this prospective study were published in JAMA Dermatology.1
The availability of effective systemic therapies for the treatment of melanoma in the metastatic setting, and increasingly in the adjuvant setting, provides an additional impetus for the upfront identification of those patients with primary localized melanoma who are at increased risk of recurrence.
Of the 1245 patients who were invited to participate in this study between October 1, 2010, and October 1, 2014, 825 patients consented and 700 were deemed eligible. All of the patients had clinically localized T1b to T4b primary cutaneous melanoma without evidence of distant metastasis and were treated at a number of hospitals and clinics in Queensland, Australia.
Study participants were asked to complete a self-administered baseline questionnaire regarding demographic characteristics and history of melanoma, followed by a biannual request to report on whether they had experienced disease recurrence by answering a yes/no question. Confirmation of clinicopathologic characteristics — including details related to lesion thickness, site, regression, mitotic rate, ulceration, and whether a sentinel lymph node biopsy was performed — was obtained through a review of medical records.
Baseline characteristics included a median age of 62.2 years, as well as male sex and no sentinel lymph node biopsy (SLNB) in 58.6% and 63.1% of the study population, respectively.
A key finding of this study was that 13.4% of patients experienced either local or distant recurrence of disease within 2 years of diagnosis.
A tumor characteristic significantly associated with disease recurrence was more advanced disease. Disease-free survival (DFS) at 2 years was 95% among patients with T1b tumors and 67% among those with T4b tumors.
Regarding SLNB, 2-year DFS was lower in patients who had not undergone this procedure compared with those who had a negative biopsy result (ie, for patients with T3a disease, 2-year DFS was 77.5% compared with 100%, respectively), leading the study authors to suggest that SLNB “should be considered routinely for use in high-risk patients.”
The site of first disease recurrence was local in 70.2% of patients in the subgroup who experienced disease recurrence, with the remaining patients in this subgroup experiencing distant disease. With respect to the latter subgroup, the most common sites of distant metastasis were the lungs (47.4%) and the CNS (31.6%).
Other tumor factors significantly associated with disease recurrence included the presence of tumor ulceration vs none (hazard ratio [HR], 1.55; P <.05), and tumor location in the head and neck compared with the trunk (HR, 1.67; P <.05). Interestingly, the risk of disease recurrence was lower for patients with tumor location in the upper limbs compared with the trunk (HR, 0.42; P <.05). Patient age and sex were not associated with disease recurrence.
Limitations of this study, identified by the study authors and the author of an accompanying editorial, include the heterogeneity of the study population regarding whether they had undergone SLNB, as well as the limited study follow-up.1,2
The study authors emphasized that “understanding the patterns and risk factors of melanoma recurrence can inform clinical follow-up recommendations.”
1. von Schuckmann LA, Hughes MCB, Ghiasvand R, et al. Risk of melanoma recurrence after diagnosis of a high-risk primary tumor. JAMA Dermatol. 2019;155(6):688-693.
2. Coit DG. The changing kinetics of advanced melanoma. JAMA Dermatol. 2019;155(6):657-659.