Prognosis after initial recurrence of cutaneous melanoma
J. S. Markowitz, L. A. Cosimi, R. W. Carey, S. Kang, C. Padyk, A. J. Sober and A. B. Cosimi
General Surgical, Massachusetts General Hospital, Boston 02114.
We reviewed 231 patients who developed recurrent disease 1 to 218 months
after surgical therapy for clinical stage I cutaneous melanoma. Metastatic
lesions amenable to surgery, including visceral recurrences, were resected.
Adjuvant systemic chemotherapy/immunotherapy or regional hyperthermic
perfusion was added in patients with unresected disease. Local irradiation
was employed for nonresectable brain or other isolated symptomatic
metastases. The overall 5-year survival rate after initial recurrence was
36%. In patients with soft tissue or nodal recurrence, the 5-year survival
rates were 49% and 38%, respectively; six (11%) of 53 patients whose
initial recurrence was in a visceral organ achieved prolonged remission.
Primary lesion anatomic site, thickness, pathologic type, and interval from
initial therapy to recurrence were unrelated to survival. Significant
prognostic factors included the site of initial metastasis, stage of
primary disease, and the successful complete eradication of gross disease
by surgical excision or intensive chemotherapy.
