Analysis of prognosis and disease progression after local recurrence of melanoma

BACKGROUND. Local recurrence of melanoma is associated with a grave prognos is. However, the characteristics and the mode of disease progression for pa tients with local recurrence have not been adequately addressed in the lite rature. METHODS, A retrospective analysis of patients treated at a single instituti on revealed a subset of patients [n = 648] with local recurrence of melanom a as a first event. Patient characteristics, histologic determinants, and d isease free interval were variables used to identify prognostic factors. RESULTS. In this group of patients, male gender (P = 0.0163), increasing ag e (P = 0.0001), head and neck primaries (P = 0.0001), thicker Breslow depth s (P = 0.0022), deeper Clark levels (P = 0.0010), and ulceration of the pri mary tumor (P = 0.0348) suggested a shorter time until local recurrence. Br eslow depth (P = 0.0004), Clark level (P = 0.0043), and ulceration (P = 0.0 001) still factored into the survival prognosis after recurrence. Truncal p rimaries (P = 0.0005) and shorter disease free intervals (P = 0.0098) were also associated with poorer outcomes after recurrence. Of the 648 patients, 124 showed no progression, 196 developed another local recurrence, 178 dev eloped in-transit/lymph node metastases, and 150 had systemic recurrences. Survival was only 33.6% for patients with further metastases, compared with 77.4% for patients with no progression of disease after a median follow-up of 38.9 months. CONCLUSIONS. There was a 48.5% mortality rate at 5 years of follow-up after local recurrence. Long term survival (> 10 years) was estimated to be 34.9 %. The patterns of failure after local recurrence suggest that patients may benefit from aggressive locoregional therapy. (C) 2000 American Cancer Soc iety.