Prognosis for recurrent stage I malignant melanoma
D. S. Reintgen, R. Vollmer, C. Y. Tso and H. F. Seigler
Department of Surgery, Duke University Medical Center, Durham, NC 27710.
The outcome of patients with stage I malignant melanoma has been well
assessed in terms of prognostic factors and their effect on survival;
however, little is known of the recurrence patterns of cutaneous melanoma
or the survival of these patients subsequent to recurrence. A
retrospective, computer-aided chart review identified 4185 patients with
melanoma who had stage I disease clinically. During a follow-up period of
one to 14 years, 35.9% suffered a recurrence. Melanoma of the trunk (37.8%)
and head and neck area (46.1%) had an increased incidence of recurrent
metastases compared with melanoma of the extremities (29.8%). Local
regional metastases accounted for 62.5%, 77.3%, and 85.6% of the
recurrences in the head and neck, trunk, and extremity primary sites,
respectively, with 65% of the relapses occurring within the first three
years. Actuarial five-year survival rates of patients who had recurrent
disease were significantly decreased compared with those of patients who
had no evidence of metastases during their clinical course. A multivariate
analysis was performed to estimate the survival of patients after
recurrence. One may use this mathematical model to predict the outcome of
individual patients after recurrence and provide a more rationally based
prognosis for them and their families.
