1ST RECURRENCE ANALYSIS OF 840 CUTANEOUS MELANOMAS - A PROPOSAL FOR AFOLLOW-UP SCHEDULE

Aims and background: A correct follow-up schedule for patients who und erwent an excision for stage I cutaneous melanoma might allow the earl y detection of local and distant metastases. At present, there is no g eneral agreement on follow-up protocols. In order to work out a follow -up guide, we have retrospectively evaluated the records of 840 stage I cutaneous melanoma patients surgically treated and followed during t he postoperative period in the Division of Plastic Surgery of the Univ ersity of Florence from 1975 to 1992. Methods: We evaluated the patien ts' records by analyzing time, pathway and site of any first recurrenc e in relation to the main prognostic factors such as patient sex, site , histological type and depth of invasion of each primary melanoma. A statistical analysis was performed. Results: To summarize, the salient results were the following: 80% of relapses occurred in the first 3 y ears and they occurred significantly earlier when the primary melanoma was localized in the trunk and significantly later when the melanoma was localized in the lower limbs and for < 1.5 mm lesions. The first r ecurrence occurred earlier by the lymphatic than by the hematic pathwa y regarding the overall number of patients. The hematic pathway was th e most frequent (with respect to the overall percentage of hematic met astases) for the melanomas localized in the head and neck region and f or lentigo malignant melanomas, whereas the lymphatic pathway was most frequent for melanomas of the lower limbs and >3 mm in thickness. Con clusions: We suggest a follow-up schedule taking into consideration th e postoperative behavior of stage I cutaneous melanoma patients (in te rms of time and pathway of the first recurrence) in relation to the si te and depth of invasion of the tumor.