658 Clinical and histopathologic risk factors for early-stage melanoma recurrence

Abstract

Emerging data suggest that the majority of patients who die from melanoma experience recurrence of disease that is early-stage (Stage I or II) at the time of diagnosis. Therefore, we aim to understand the clinical (demographics, medical history, surgical margins) and histopathologic (synoptic features) characteristics that influence early-stage melanoma recurrence utilizing a multi-institutional database comprising of 1,244 patients with 1,342 early-stage primary cutaneous melanomas from 2000-2020. A multivariable Cox proportional hazards model with clustering adjustment was used to analyze the risk for melanoma recurrence. Harrell C’s concordance index was used to assess the goodness of fit. 331 (24.7%) of melanomas recurred within the study period. Among the recurrent melanomas, 52% of patients progressed to develop metastatic disease and 39.9% were deceased at end of follow-up. In univariate modeling for risk of melanoma recurrence, Breslow depth, AJCC stage, and tumor mitotic rate had the highest Harrell’s C (0.8, 0.77, and 0.77 respectively) and were at significantly higher risk of melanoma recurrence. Multivariate modeling demonstrated that individuals who are older at diagnosis (HR 1.02, p<0.001), in the second quartile of income range of $77,484-$99,677 (HR 1.36, p=0.046), Clark’s level above 4, melanoma stage above 2A, with the presence of tumor-infiltrating lymphocytes (HR 1.51, p=0.02), and presence of mitoses (HR 2.09, p=0.001) were at higher risk of melanoma recurrence. The risk factors identified above, particularly mitotic rate, can guide clinicians in risk stratifying patients with early-stage melanoma for increased surveillance to detect recurrence.