Primary melanoma with regression: Implications for management

Abstract

7530 Background: Regression is observed in approximately 5% of patients with primary cutaneous melanomas. The implications of regression for treatment are controversial. Some advocate a wider margin of resection and a lower threshold for sentinel lymph node (SLN) biopsy in this setting. We review our recent experience in order to determine whether this approach is warranted. Methods: We identified 71 patients treated at Memorial Sloan- Kettering between 1995 and 2000 with regression noted on review of the primary melanoma. Information about patient, tumor, treatment, and outcomes were obtained from review of the medical records. Results: There were 23 females and 48 males with a median age of 58. The most common primary site was the trunk (n=52, 73%), followed by extremity (n=17, 24%). Median Breslow depth of the primary melanoma for patients with invasive disease (n=63) was 0.7 mm (range 0.21 to 21 mm). There were 14 recurrences among the 71 patients (20%) at a mean follow-up of 29 months. Of those with recurrence, the initial site was distant metastasis in 10 patients followed by local recurrence in 4. SLN biopsy was performed in 29 patients and was positive in 6 (21%). All patients with positive SLNs had primary melanomas over 3 mm in Breslow depth. Of the 29 patients with “extensive” or “prominent” regression, 5 (17%) had recurrences, 4 of which were distant metastases. Conclusions: The presence of regression in a primary melanoma does not warrant adjustment of current treatment recommendations. We found no evidence that these patients are at higher risk for local or regional nodal recurrence. No significant financial relationships to disclose.