Main risk factors for local recurrence in patients with cutaneous melanoma — single center study
Abstract
Introduction. True scar recurrence (persistent disease) that develops at the site of wide excision of primary cutaneous melanoma is defined as the presence of in situ and/or radial phase of growth of a melanoma that is within or near the surgical scar This study aims to present the main risk factors associated with the appearance of local recurrence in patients with melanoma of the skin, as well as the negative impact of local recurrence on overall survival.
Material and methods. We included 144 patients with skin melanoma in the study who were operated on at UMHAT “Dr. Georgi Stranski” Pleven, Bulgaria, during the period 2012–2017.
Results. Achromic skin melanoma was significantly (χ² = 15.668; df = 1; p = 0.001) more frequent in patients with locally recurrent melanoma. Metastatic melanoma was more common in patients with local recurrence (73% vs. 16.3%; χ² = 25.308; df = 1; p = 0.001). The overall median survival of all patients was 75.9 [95% confidence interval (CI) 69.7–82.0] months and it was lower [95% CI 52.8 (39.8–65.8) vs. 95% CI 77.7 (71.1–84.2)] in patients with local melanoma recurrence, although the differences were not significant (p = 0.076).
Conclusions. The achromic type and the greater thickness and depth of invasion of the primary skin melanoma are major risk factors for the development of local recurrence. The presence of local recurrence of the disease is associated with a high rate of distant metastases. The development of local recurrence in patients with cutaneous melanoma significantly worsens the overall survival of the disease.
Keywords: local recurrencesmelanomaachromic melanomapigment melanomareexcisionexcision
References
- Swetter SM, Johnson D, Albertini MR, et al. NCCN Guidelines® Insights: Melanoma: Cutaneous, Version 2.2024. J Natl Compr Canc Netw. 2024; 22(5): 290–298.
- McKinnon JG, Starritt EC, Scolyer RA, et al. Histopathologic excision margin affects local recurrence rate: analysis of 2681 patients with melanomas < or =2 mm thick. Ann Surg. 2005; 241(2): 326–333.
- Sladden MJ, Balch C, Barzilai DA, et al. Surgical excision margins for primary cutaneous melanoma. Cochrane Database Syst Rev. 2009(4): CD004835.
- Pride RLD, Miller CJ, Murad MH, et al. Local Recurrence of Melanoma Is Higher After Wide Local Excision Versus Mohs Micrographic Surgery or Staged Excision: A Systematic Review and Meta-analysis. Dermatol Surg. 2022; 48(2): 164–170.
- Cho SI, Lee J, Jo G, et al. Local recurrence and metastasis in patients with malignant melanomas after surgery: A single-center analysis of 202 patients in South Korea. PLoS One. 2019; 14(3): e0213475.
- Zaremba A, Philip M, Hassel JC, et al. Clinical characteristics and therapy response in unresectable melanoma patients stage IIIB-IIID with in-transit and satellite metastases. Eur J Cancer. 2021; 152: 139–154.
- Read RL, Haydu L, Saw RPM, et al. In-transit melanoma metastases: incidence, prognosis, and the role of lymphadenectomy. Ann Surg Oncol. 2015; 22(2): 475–481.
- Bann DV, Chaikhoutdinov I, Zhu J, et al. Satellite and In-Transit Metastatic Disease in Melanoma Skin Cancer: A Retrospective Review of Disease Presentation, Treatment, and Outcomes. Dermatol Surg. 2019; 45(3): 371–380.
- Testori A, Ribero S, Bataille V. Diagnosis and treatment of in-transit melanoma metastases. Eur J Surg Oncol. 2017; 43(3): 544–560.
- Wright FC, Kellett S, Hong NJ, et al. Locoregional management of in-transit metastasis in melanoma: an Ontario Health (Cancer Care Ontario) clinical practice guideline. Curr Oncol. 2020; 27(3): e318–e325.
- Amaral T, Ottaviano M, Arance A, et al. ESMO Guidelines Committee. Electronic address: clinicalguidelines@esmo.org. Cutaneous melanoma: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Ann Oncol. 2025; 36(1): 10–30.
- Rutkowski P, Wysocki P, Kozak K, et al. Expert recommendations on diagnostic-therapeutic management of melanoma patients. Oncology in Clinical Practice. 2022; 18(6): 357–392.
- Hayes AJ, Clark MA, Harries M, et al. Management of in-transit metastases from cutaneous malignant melanoma. Br J Surg. 2004; 91(6): 673–682.
- Gimbel MI, Delman KA, Zager JS. Therapy for unresectable recurrent and in-transit extremity melanoma. Cancer Control. 2008; 15(3): 225–232.
- Hafez K, MacCormick R. Malignant Melanoma, with emphasis on first relapse cases. Journal of Taibah University Medical Sciences. 2012; 7(2): 81–86.
- Garbe C, Amaral T, Peris K, et al. European Dermatology Forum (EDF), the European Association of Dermato-Oncology (EADO), and the European Organization for Research and Treatment of Cancer (EORTC). European consensus-based interdisciplinary guideline for melanoma. Part 1: Diagnostics: Update 2022. Eur J Cancer. 2022; 170: 236–255.
- Goel MK, Khanna P, Kishore J. Understanding survival analysis: Kaplan-Meier estimate. Int J Ayurveda Res. 2010; 1(4): 274–278.
- Pazdrowski J, Szewczyk M, Pazdrowski P, et al. Risk factors for local and nodal recurrence in patients with head and neck cutaneous squamous cell carcinoma in a high-reference oncological center in Poland. Rep Pract Oncol Radiother. 2024; 29(2): 204–210.
- Essner R. Surgical treatment of malignant melanoma. Surg Clin North Am. 2003; 83(1): 109–156.
- Garbe C, Peris K, Hauschild A, et al. European Dermatology Forum, European Association of Dermato-Oncology, European Organization of Research and Treatment of Cancer. Diagnosis and treatment of melanoma. European consensus-based interdisciplinary guideline--Update 2012. Eur J Cancer. 2012; 48(15): 2375–2390.
- Straker RJ, Kelly N, Sharon CE, et al. Local recurrence in patients undergoing wide excision and sentinel lymph node biopsy for cutaneous malignant melanoma: A single-center, retrospective cohort analysis. J Am Acad Dermatol. 2022; 87(1): 247–250.
- Bhave P, Pallan L, Long GV, et al. Melanoma recurrence patterns and management after adjuvant targeted therapy: a multicentre analysis. Br J Cancer. 2021; 124(3): 574–580.
- Woodford R, McKeown J, Hoeijmakers LL, et al. Nature and management of melanoma recurrences following adjuvant anti-PD-1 based therapy. Eur J Cancer. 2024; 212: 115055.
- Leeneman B, Franken MG, Coupé VMH, et al. Stage-specific disease recurrence and survival in localized and regionally advanced cutaneous melanoma. Eur J Surg Oncol. 2019; 45(5): 825–831.
- Ertekin SS, Podlipnik S, Riquelme-Mc Loughlin C, et al. Initial Stage of Cutaneous Primary Melanoma Plays a Key Role in the Pattern and Timing of Disease Recurrence. Acta Derm Venereol. 2021; 101(7): adv00502.
- Wen X, Li D, Zhao J, et al. Time-varying pattern of recurrence risk for localized melanoma in China. World J Surg Oncol. 2020; 18(1): 6.
- Marcoval J, Ferreres JR, Penín RM, et al. Descriptive Analysis of Cutaneous Recurrence Patterns in Patients with Melanoma. Actas Dermo-Sifiliográficas (English Edition). 2011; 102(10): 791–796.
- von Schuckmann LA, Hughes MC, Ghiasvand R, et al. Risk of Melanoma Recurrence After Diagnosis of a High-Risk Primary Tumor. JAMA Dermatol. 2019; 155(6): 688–693.
- Balch CM, Urist MM, Karakousis CP, et al. Efficacy of 2-cm surgical margins for intermediate-thickness melanomas (1 to 4 mm). Results of a multi-institutional randomized surgical trial. Ann Surg. 1993; 218(3): 262–7; discussion 267.
- Thomas NE, Kricker A, Waxweiler WT, et al. Genes, Environment, and Melanoma (GEM) Study Group. Comparison of clinicopathologic features and survival of histopathologically amelanotic and pigmented melanomas: a population-based study. JAMA Dermatol. 2014; 150(12): 1306–1314.
- Villani A, Fabbrocini G, Costa C, et al. Second primary melanoma: incidence rate and risk factors. J Eur Acad Dermatol Venereol. 2020; 34(10): e623–e624.
- Hopkins ZH, Carlisle RP, Frost ZE, et al. Risk Factors and Predictors of Survival Among Patients with Amelanotic Melanoma Compared to Melanotic Melanoma in the National Cancer Database. J Clin Aesthet Dermatol. 2021; 14(12): 36–43.
- Perez M, Tanabe K, Ariyan C, et al. Local and Recurrent Regional Metastases of Melanoma. Cutaneous Melanoma. 2020: 705–737.
- Bancalari B, Ferrer-Guillen S, Tejera-Vaquerizo A, et al. Longitudinal study of prognostic factors for localized cutaneous melanoma in patients who have been disease-free for five years. Eur J Dermatol. 2021; 31(2): 192–198.
- Vița O, Jurescu A, Văduva A, et al. Invasive Cutaneous Melanoma: Evaluating the Prognostic Significance of Some Parameters Associated with Lymph Node Metastases. Medicina (Kaunas). 2023; 59(7).
- Suojärvi NJ, Jahkola TA, Virolainen S, et al. Outcome following local recurrence or in-transit metastases in cutaneous melanoma. Melanoma Res. 2012; 22(6): 447–453.
- Dong X, Tyler D, Johnson J, et al. Analysis of prognosis and disease progression after local recurrence of melanoma. Cancer. 2000; 88(5): 1063–1071, doi: 10.1002/(sici)1097-0142(20000301)88:5<1063::aid-cncr17>3.0.co;2-e.