Abstract
BackgroundWhile curable at early stages, few treatment options exist for advanced melanoma. Currently, no consensus exists regarding the optimal surveillance strategy for patients after resection. The objectives of this study were to identify patterns of metastatic recurrence, to determine the influence of metastatic site on survival, and to identify high-risk periods for recurrence.MethodsA retrospective review of the Duke Melanoma Database from 1970 to 2004 was conducted that focused on patients who were initially diagnosed without metastatic disease. The time to first recurrence was computed from the date of diagnosis, and the associated hazard function was examined to determine the peak risk period of recurrence. Metastatic sites were coded by the American Joint Committee on Cancer (AJCC) system including local skin, distant skin and nodes (M1a), lung (M1b), and other distant (M1c).ResultsOf 11,615 patients initially diagnosed without metastatic disease, 4616 (40%) had at least one recurrence. Overall the risk of initial recurrence peaked at 12 months. The risk of initial recurrence at the local skin, distant skin, and nodes peaked at 8 months, and the risk at lung and other distant sites peaked at 24 months. Patients with a cutaneous or nodal recurrence had improved survival compared to other recurrence types.ConclusionsThe risk of developing recurrent melanoma peaked at one year, and the site of first recurrence had a significant impact on survival. Defining the timing and expected patterns of recurrence will be important in creating an optimized surveillance strategy for this patient population.
Highlights
Melanoma is one of the few cancers whose incidence continues to rise, and in 2012, an estimated 76,250 new cases will be diagnosed in the United States [1]
Approximately 20–30% of early stage melanoma patients develop a recurrence during their lifetime, with much higher rates seen in patients with regionally advanced disease [2]
From 1970 to 2004, 14,029 patients with melanoma were treated at Duke Univerisity Medical Center
Summary
Melanoma is one of the few cancers whose incidence continues to rise, and in 2012, an estimated 76,250 new cases will be diagnosed in the United States [1]. Timing of imaging surveillance is often guided by the data collection processes used in clinical trials, practical aspects of clinical care, experience in other cancers, and anecdote. The objective of this study was to determine high-risk periods of recurrence by metastatic site as a first step to designing practical surveillance care for patients with melanoma. For the over 800,000 people currently living in the United States with a previous diagnosis of melanoma, a rationally designed surveillance strategy could allow for improved disease outcomes, time savings, and a reduction in wasteful health resource utilization [9]. The objectives of this study were to identify patterns of metastatic recurrence, to determine the influence of metastatic site on survival, and to identify high-risk periods for recurrence
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