LOCAL MELANOMA RECURRENCES IN THE SCAR AFTER LIMITED SURGERY FOR PRIMARY TUMOR

The clinical and histologic records of 46 consecutive patients mere re viewed who during the period 1980-1993 had recurrence from melanoma in the scar after limited surgery for a skin tumor. They constituted abo ut 50% of all patients admitted with local recurrence from melanoma du ring this period. At reexamination of the primary tumors, 16 were foun d to be malignant melanomas and 9 were nevi (four atypical and five be nign). Twenty-one specimens were missing, 11 of which had never been s ent for histologic examination. The median thickness of nine measurabl e melanomas was 0.66 mm. The recurrences in scar consisted of 34 prima ry melanomas: 18 superficial spreading, 4 nodular, 3 lentigo malignant , and 9 unclassified. Twelve tumors were dermal melanoma metastases. T he median thickness of the 25 measurable melanomas was 0.78 mm. The 5- year overall survival was 69%. At the closing date of the study 15 pat ients had died, 13 of them because of disseminated melanoma, A compari son of the survival curves from this study with those from other serie s of melanomas with comparable tumor thickness indicates a considerabl y worse prognosis than is expected with such thin tumors. We believe t hat the considerable number of local recurrences in the form of a new primary in a scar following limited surgery supports the theory of lim ited held change around a primary melanoma. Furthermore, limited proce dures for primary melanoma, if followed by a recurrence in the scar, w orsen the prognosis.