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Prognosis After Initial Recurrence of Cutaneous Melanoma

Prognosis After Initial Recurrence of Cutaneous Melanoma Abstract • We reviewed 231 patients who developed recurrent disease 1 to 218 months after surgical therapy for clinical stage I cutaneous melanoma. Metastatic lesions amenable to surgery, including visceral recurrences, were resected. Adjuvant systemic chemotherapy/immunotherapy or regional hyperthermic perfusion was added in patients with unresected disease. Local irradiation was employed for nonresectable brain or other isolated symptomatic metastases. The overall 5-year survival rate after initial recurrence was 36%. In patients with soft tissue or nodal recurrence, the 5-year survival rates were 49% and 38%, respectively; six (11%) of 53 patients whose initial recurrence was in a visceral organ achieved prolonged remission. Primary lesion anatomic site, thickness, pathologic type, and interval from initial therapy to recurrence were unrelated to survival. Significant prognostic factors included the site of initial metastasis, stage of primary disease, and the successful complete eradication of gross disease by surgical excision or intensive chemotherapy. (Arch Surg. 1991;126:703-708) References 1. Cosimi AB, Sober AJ, Mihm MC, Fitzpatrick TB. Conservative surgical management of superficially invasive cutaneous melanoma . Cancer . 1984;53:1256-1259.Crossref 2. Day CL, Lew RA, Mihm MC, et al. The natural break points for primary tumor thickness in clinical stage I melanoma . N Engl J Med . 1981;305:1155. 3. Wood WC, Cosimi AB, Carey RW, Kaufman SD. Randomized trial of adjuvant therapy for 'high risk' primary malignant melanoma . Surgery . 1978;83:677-681. 4. Kaplan EL, Meier P. Nonparametric estimation from incomplete observation . J Am Stat Assoc . 1958;53:457-481.Crossref 5. Cox DR. Regression model and life tables . J R Stat Soc . 1972;B34:187-220. 6. Balch CM, Soong SJ, Murad TM, Smith JW, Maddox WA, Durant JR. A multi-factorial analysis of melanoma, IV: prognostic factors in 200 melanoma patients with distant metastases (stage III) . J Clin Oncol . 1983;1:126-134. 7. Shaw HM, Beattie CW, McCarthy WH, Milton GW. Late relapse from cutaneous stage I malignant melanoma . Arch Surg . 1985;120:1155-1159.Crossref 8. Karakousis CP, Temple DF, Moore R, Ambrus JL. Prognostic parameters in recurrent malignant melanoma . Cancer . 1983;52:575-579.Crossref 9. Reintgen DS, Vollmer R, Tso CY, Seigler HF. Prognosis for recurrent stage I malignant melanoma . Arch Surg . 1987;122:1338-1342.Crossref 10. Elias EG, Didolkar MS, Goel IP, et al. A clinicopathologic study of prognostic factors in cutaneous malignant melanoma . Surg Gynecol Obstet . 1977;144:327-334. 11. Klaase JM, Kroon BBR. Surgery for melanoma metastatic to the gastrointestinal tract . Br J Surg . 1990;77:60-61.Crossref 12. Fuen LG, Gutterman J, Burgess MA, et al. The natural history of resectable metastatic melanoma (stage IVA melanoma) . Cancer . 1982;50:1656-1663.Crossref 13. Singletary SE, Tucker SL, Boddie AW. Multivariate analysis of prognostic factors in regional cutaneous metastases of extremity melanoma . Cancer . 1988;61:1437-1440.Crossref 14. Treidman L, McNeer G. Prognosis with local metastasis and recurrence in malignant melanoma . Ann N Y Acad Sci . 1963;100:123-130. 15. Fortner JG, Strong EW, Mulcare RJ, Schottenfeld D, Maclean BJ. The surgical treatment of recurrent melanoma . Surg Clin North Am . 1974;54:865-870. 16. Crowley NJ, Seigler HF. Late recurrence of malignant melanoma . Ann Surg . 1990;212:173-177.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

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Publisher
American Medical Association
Copyright
Copyright © 1991 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1991.01410300045006
Publisher site
See Article on Publisher Site

Abstract

Abstract • We reviewed 231 patients who developed recurrent disease 1 to 218 months after surgical therapy for clinical stage I cutaneous melanoma. Metastatic lesions amenable to surgery, including visceral recurrences, were resected. Adjuvant systemic chemotherapy/immunotherapy or regional hyperthermic perfusion was added in patients with unresected disease. Local irradiation was employed for nonresectable brain or other isolated symptomatic metastases. The overall 5-year survival rate after initial recurrence was 36%. In patients with soft tissue or nodal recurrence, the 5-year survival rates were 49% and 38%, respectively; six (11%) of 53 patients whose initial recurrence was in a visceral organ achieved prolonged remission. Primary lesion anatomic site, thickness, pathologic type, and interval from initial therapy to recurrence were unrelated to survival. Significant prognostic factors included the site of initial metastasis, stage of primary disease, and the successful complete eradication of gross disease by surgical excision or intensive chemotherapy. (Arch Surg. 1991;126:703-708) References 1. Cosimi AB, Sober AJ, Mihm MC, Fitzpatrick TB. Conservative surgical management of superficially invasive cutaneous melanoma . Cancer . 1984;53:1256-1259.Crossref 2. Day CL, Lew RA, Mihm MC, et al. The natural break points for primary tumor thickness in clinical stage I melanoma . N Engl J Med . 1981;305:1155. 3. Wood WC, Cosimi AB, Carey RW, Kaufman SD. Randomized trial of adjuvant therapy for 'high risk' primary malignant melanoma . Surgery . 1978;83:677-681. 4. Kaplan EL, Meier P. Nonparametric estimation from incomplete observation . J Am Stat Assoc . 1958;53:457-481.Crossref 5. Cox DR. Regression model and life tables . J R Stat Soc . 1972;B34:187-220. 6. Balch CM, Soong SJ, Murad TM, Smith JW, Maddox WA, Durant JR. A multi-factorial analysis of melanoma, IV: prognostic factors in 200 melanoma patients with distant metastases (stage III) . J Clin Oncol . 1983;1:126-134. 7. Shaw HM, Beattie CW, McCarthy WH, Milton GW. Late relapse from cutaneous stage I malignant melanoma . Arch Surg . 1985;120:1155-1159.Crossref 8. Karakousis CP, Temple DF, Moore R, Ambrus JL. Prognostic parameters in recurrent malignant melanoma . Cancer . 1983;52:575-579.Crossref 9. Reintgen DS, Vollmer R, Tso CY, Seigler HF. Prognosis for recurrent stage I malignant melanoma . Arch Surg . 1987;122:1338-1342.Crossref 10. Elias EG, Didolkar MS, Goel IP, et al. A clinicopathologic study of prognostic factors in cutaneous malignant melanoma . Surg Gynecol Obstet . 1977;144:327-334. 11. Klaase JM, Kroon BBR. Surgery for melanoma metastatic to the gastrointestinal tract . Br J Surg . 1990;77:60-61.Crossref 12. Fuen LG, Gutterman J, Burgess MA, et al. The natural history of resectable metastatic melanoma (stage IVA melanoma) . Cancer . 1982;50:1656-1663.Crossref 13. Singletary SE, Tucker SL, Boddie AW. Multivariate analysis of prognostic factors in regional cutaneous metastases of extremity melanoma . Cancer . 1988;61:1437-1440.Crossref 14. Treidman L, McNeer G. Prognosis with local metastasis and recurrence in malignant melanoma . Ann N Y Acad Sci . 1963;100:123-130. 15. Fortner JG, Strong EW, Mulcare RJ, Schottenfeld D, Maclean BJ. The surgical treatment of recurrent melanoma . Surg Clin North Am . 1974;54:865-870. 16. Crowley NJ, Seigler HF. Late recurrence of malignant melanoma . Ann Surg . 1990;212:173-177.Crossref

Journal

Archives of SurgeryAmerican Medical Association

Published: Jun 1, 1991

References