Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 4/2017

01-04-2017 | Melanomas

Patterns and Timing of Initial Relapse in Pathologic Stage II Melanoma Patients

Authors: Ann Y. Lee, MD, Nicolas Droppelmann, MD, Katherine S. Panageas, DrPH, Qin Zhou, MA, Charlotte E. Ariyan, MD, Mary S. Brady, MD, Paul B. Chapman, MD, Daniel G. Coit, MD

Published in: Annals of Surgical Oncology | Issue 4/2017

Login to get access

Abstract

Purpose

Pathologic stage II melanoma patients have variable outcomes when divided by substage. We hypothesized that an understanding of the patterns of initial relapse by substage will better inform follow-up guidelines.

Methods

We performed a retrospective review of 738 adult patients with pathologic stage II cutaneous melanoma treated at Memorial Sloan Kettering Cancer Center between 1993 and 2013. Clinical records were reviewed to determine time, location, and method of detection of initial relapse.

Results

At a median follow-up of 52 months, 219 patients relapsed. Relapses were detected more frequently in higher substages. Initial relapses were most commonly local/in-transit for IIA and IIB and systemic for IIC. Lung and brain were the most frequent sites of systemic relapse. Patient-detection was the most common method of relapse detection (59%) in all substages. The 5-year cumulative incidence for patient-detected relapse was 13.6% for IIA, 18.9% for IIB, and 23.3% for IIC and for image-detected relapse was 3.4, 7.9, and 16.6%, respectively. The 5-year cumulative incidence for physician-detected relapse was less than 10% across all substages and leveled off at 3 years for stage IIA and IIB and 2 years for stage IIC.

Conclusions

Relapses were most frequently patient-detected in all stage II substages, highlighting the importance of patient education and self-examination. The highest yield for routine imaging is in stage IIC patients during the first 4 years. Physician examination is unlikely to detect relapses beyond 3 years for stage IIA and IIB and beyond 2 years for stage IIC patients.
Appendix
Available only for authorised users
Literature
1.
2.
Romano E, Scordo M, Dusza SW, Coit DG, Chapman PB. Site and timing of first relapse in stage III melanoma patients: implications for follow-up guidelines. J Clin Oncol. 2010;28(18):3042–7.CrossRefPubMedPubMedCentral
3.
4.
Xing Y, Cromwell KD, Cormier JN. Review of diagnostic imaging modalities for the surveillance of melanoma patients. Dermatol Res Pract. 2012;2012:941921.PubMed
5.
Garbe C, Paul A, Kohler-Spath H, et al. Prospective evaluation of a follow-up schedule in cutaneous melanoma patients: recommendations for an effective follow-up strategy. J Clin Oncol. 2003;21(3):520–9.CrossRefPubMed
6.
Livingstone E, Eigentler TK, Windemuth-Kieselbach C, et al. Actual practice of melanoma follow-up and treatment in Germany: results of a prospective, longitudinal cohort study. Br J Dermatol. 2015;172(6):1646-50.CrossRefPubMed
7.
Damude S, Hoekstra-Weebers JE, Francken AB, Ter Meulen S, Bastiaannet E, Hoekstra HJ. The MELFO Study: prospective, randomized, clinical trial for the evaluation of a stage-adjusted reduced follow-up schedule in cutaneous melanoma patients-results after 1 year. Ann Surg Oncol. 2016;23(9):2762–71.CrossRefPubMedPubMedCentral
8.
9.
Moore Dalal K, Zhou Q, Panageas KS, Brady MS, Jaques DP, Coit DG. Methods of detection of first recurrence in patients with stage I/II primary cutaneous melanoma after sentinel lymph node biopsy. Ann Surg Oncol. 2008;15(8):2206–14.CrossRefPubMed
10.
Francken AB, Shaw HM, Accortt NA, Soong SJ, Hoekstra HJ, Thompson JF. Detection of first relapse in cutaneous melanoma patients: implications for the formulation of evidence-based follow-up guidelines. Ann Surg Oncol. 2007;14(6):1924–33.CrossRefPubMed
11.
Meyers MO, Yeh JJ, Frank J, et al. Method of detection of initial recurrence of stage II/III cutaneous melanoma: analysis of the utility of follow-up staging. Ann Surg Oncol. 2009;16(4):941–7.CrossRefPubMed
12.
Regan MW, Reid CD, Griffiths RW, Briggs JC. Malignant melanoma, evaluation of clinical follow up by questionnaire survey. Br J Plastic Surg. 1985;38(1):11–4.CrossRef
13.
Hofmann U, Szedlak M, Rittgen W, Jung EG, Schadendorf D. Primary staging and follow-up in melanoma patients–monocenter evaluation of methods, costs and patient survival. Br J Cancer. 2002;87(2):151–7.CrossRefPubMedPubMedCentral
14.
Bradford PT, Freedman DM, Goldstein AM, Tucker MA. Increased risk of second primary cancers after a diagnosis of melanoma. Arch Dermatol. 2010;146(3):265–72.CrossRefPubMedPubMedCentral
15.
Caini S, Boniol M, Botteri E, et al. The risk of developing a second primary cancer in melanoma patients: a comprehensive review of the literature and meta-analysis. J Dermatol Sci. 2014;75(1):3–9.CrossRefPubMed
16.
Austin PF, Cruse CW, Lyman G, Schroer K, Glass F, Reintgen DS. Age as a prognostic factor in the malignant melanoma population. Ann Surg Oncol. 1994;1(6):487–94.CrossRefPubMed
17.
Schuchter L, Schultz DJ, Synnestvedt M, et al. A prognostic model for predicting 10-year survival in patients with primary melanoma. The Pigmented Lesion Group. Ann Intern Med. 1996;125(5):369–75.CrossRefPubMed
18.
Balch CM, Soong SJ, Gershenwald JE, et al. Prognostic factors analysis of 17,600 melanoma patients: validation of the American Joint Committee on Cancer melanoma staging system. J Clin Oncol. 2001;19(16):3622–34.CrossRefPubMed
19.
Masback A, Olsson H, Westerdahl J, Ingvar C, Jonsson N. Prognostic factors in invasive cutaneous malignant melanoma: a population-based study and review. Melanoma Res. 2001;11(5):435–45.CrossRefPubMed
20.
Rueth NM, Xing Y, Chiang YJ, et al. Is surveillance imaging effective for detecting surgically treatable recurrences in patients with melanoma? A comparative analysis of stage-specific surveillance strategies. Ann Surg. 2014;259(6):1215–22.CrossRefPubMed
21.
Hengge UR, Wallerand A, Stutzki A, Kockel N. Cost-effectiveness of reduced follow-up in malignant melanoma. J German Soc Dermatol. 2007;5(10):898–907.
22.
Dicker TJ, Kavanagh GM, Herd RM, et al. A rational approach to melanoma follow-up in patients with primary cutaneous melanoma. Scottish Melanoma Group. Br J Dermatol. 1999;140(2):249–54.CrossRefPubMed
23.
Nguyen T, Kuo C, Nicholl MB, et al. Downregulation of microRNA-29c is associated with hypermethylation of tumor-related genes and disease outcome in cutaneous melanoma. Epigenetics. 2011;6(3):388–94.CrossRefPubMedPubMedCentral
24.
25.
Larkin J, Chiarion-Sileni V, Gonzalez R, et al. Combined Nivolumab and Ipilimumab or Monotherapy in Untreated Melanoma. N Engl J Med. 2015;373(1):23–34.CrossRefPubMed
26.
Postow MA, Chesney J, Pavlick AC, et al. Nivolumab and ipilimumab versus ipilimumab in untreated melanoma. N Engl J Med. 2015;372(21):2006–17.CrossRefPubMed
27.
Chapman PB, Hauschild A, Robert C, et al. Improved survival with vemurafenib in melanoma with BRAF V600E mutation. N Engl J Med. 2011;364(26):2507–16.CrossRefPubMedPubMedCentral
28.
29.
Metadata
Title
Patterns and Timing of Initial Relapse in Pathologic Stage II Melanoma Patients
Authors
Ann Y. Lee, MD
Nicolas Droppelmann, MD
Katherine S. Panageas, DrPH
Qin Zhou, MA
Charlotte E. Ariyan, MD
Mary S. Brady, MD
Paul B. Chapman, MD
Daniel G. Coit, MD
Publication date
01-04-2017
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 4/2017
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-016-5642-0

Other articles of this Issue 4/2017

Annals of Surgical Oncology 4/2017 Go to the issue

Hepatobiliary Tumors

Positron Emission Tomography-Computed Tomography for Patients with Recurrent Colorectal Liver Metastases: Impact on Restaging and Treatment Planning

Gastrointestinal Oncology

Current Delivery of Hyperthermic Intraperitoneal Chemotherapy with Cytoreductive Surgery (CS/HIPEC) and Perioperative Practices: An International Survey of High-Volume Surgeons

Hepatobiliary Tumors

Laparoscopic Glissonean Pedicle Transection (Takasaki) for Negative Fluorescent Counterstaining of Segment 6

Gastrointestinal Oncology

Reliable Surgical Techniques for Lymphadenectomy Along the Left Recurrent Laryngeal Nerve During Thoracoscopic Esophagectomy in the Prone Position

Colorectal Cancer

Survival Outcome and Risk of Metachronous Colorectal Cancer After Surgery in Lynch Syndrome

Melanomas

Thin Melanoma with Nodal Involvement: Analysis of Demographic, Pathologic, and Treatment Factors with Regard to Prognosis