Ulceration, tumor thickness, and anatomic site were associated with recurrence in patients with stage I and II melanoma, along with additional pathologic features not included in current staging systems, according to a cohort study published in JAMA Dermatology.
That finding comes from a cohort study in which researchers evaluated which clinical and pathologic factors were associated with recurrence in localized melanoma. The analysis included patients with stage IA to IIC melanoma diagnosed between 2010 and 2017.
Among 1,092 patients (median age, 60 years; 57% male), 16% experienced recurrence over a median follow-up of 7 years. Median time to recurrence was 2 years, with shorter intervals observed in higher-stage disease. Recurrence increased stepwise from 4% in stage IA to 37% in stage IIB and 36% in stage IIC. Distant recurrence was the most common pattern, accounting for 48% of cases.
In multivariable analysis, ulceration and increasing tumor thickness remained associated with recurrence. Tumor location was also significant, with melanomas on the scalp or neck and face more likely to recur compared with those on the arms.
Additional models incorporating variables with missing data showed that neurotropism, lymphovascular invasion, and presence of mitoses were also associated with shorter time to recurrence. These variables were not consistently included in standard staging criteria but remained significant in extended multivariable models.
Univariable analyses showed similar patterns, with higher recurrence associated with tumor features such as ulceration, mitoses, and scalp or neck location, as well as patient factors including older age, male sex, higher comorbidity burden, and federal insurance.
Kaplan-Meier analyses (Figure, pages 5–6) demonstrated reduced recurrence-free survival in melanomas located on the face or scalp or neck, as well as in tumors with neurotropism, lymphovascular invasion, or mitoses.
The cohort included patients regardless of sentinel lymph node biopsy status, including those who did not meet criteria for biopsy.
The researchers noted several limitations, including missing data for some pathologic variables, single-center design, and the possibility that some recurrences were captured outside the institution.
“Several clinicopathologic variables…are associated with time to melanoma recurrence,” wrote lead study author Maya Mundada, BS, of the University of California, San Francisco, and colleagues, adding that incorporating these factors “could help guide surveillance for recurrences.”
One author reported grants from the National Institutes of Health during the conduct of the study; no other disclosures were reported.
Source: JAMA Network
