Background:
Local recurrence of melanoma is associated with a grave prognosis. however, the characteristics and the mode of disease progression for patients with local recurrence have not been adequately addressed in the literature.
Methods:
A retrospective analysis of patients treated at a single institution revealed a subset of patients (n = 648) with local recurrence of melanoma as a first event. patient characteristics, histologic determinants, and disease free interval were variables used to identify prognostic factors.
Results:
In this group of patients, male gender (p = 0. 0163), increasing age (p = 0.0001), head and neck primaries (p = 0. 0001), thicker breslow depths (p = 0.0022), deeper clark levels (p = 0.0010), and ulceration of the primary tumor (p = 0.0348) suggested a shorter time until local recurrence. breslow depth (p = 0.0004), clark level (p = 0.0043), and ulceration (p = 0.0001) still factored into the survival prognosis after recurrence. truncal primaries (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 developed 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.