FACTORS AFFECTING SURVIVAL FOLLOWING LOCAL, REGIONAL, OR DISTANT RECURRENCE FROM LOCALIZED MELANOMA

Background and Objectives: Approximately one third of all melanoma pat ients will experience disease recurrence. Factors that affect patient survival following local, regional, or distant first recurrences of lo calized melanoma are the subject of this investigation. Methods: Survi val times for a total of 1,085 first recurrences from 4,568 localized melanoma patients were examined in relationship to patient and disease factors by Cox regression. Nearly half (48.8%) of all first recurrenc es were regional, 21.8% were local, and 29.4% were distant recurrences . Results: Survival following recurrence differed significantly by sit e of recurrence (local, regional, or distant; P < 0.0001). Within each site, the median survival time did not differ by time of recurrence f ollowing diagnosis. Significant tumor factors for survival following l ocal recurrence included tumor thickness (P = 0.0263) and lesion locat ion (P < 0.0001). For regional recurrences, survival was significantly related to ulceration (P = 0.0105) and whether the recurrence was com bined with a local recurrence (P = 0.0439). Survival following distant metastasis was related to number of distant sites (P < 0.0001) and wh ether a visceral site was involved (P < 0.0001). Conclusions: Patient and tumor characteristics predict survival following recurrence. Regar dless of disease-free interval, long-term follow-up of melanoma patien ts is necessary. Patients experiencing distant metastasis have the sho rtest median survival time compared to patients experiencing local or regional recurrences. (C) 1998 Wiley-Liss, Inc.