Among patients with melanoma recurrence, 40.7% reported at least one key symptom identified through the ATLAS mnemonic, with other cases detected through physician examination (10.7%) and CT scans (35.7%), according to a new study.

A retrospective cohort study at a multidisciplinary melanoma clinic explored high-yield patient-reported symptoms associated with melanoma recurrence to enhance surveillance strategies. The study, published in the Journal of the American Academy of Dermatology, included 281 patients diagnosed with cutaneous melanoma (CM) between 2010 and 2017 at a tertiary academic medical center, with 189 patients experiencing recurrence and 92 showing no recurrence during the study period.

The researchers analyzed comprehensive demographic and clinical data, including tumor staging, smoking history, and a detailed review of systems. Recurrence was significantly associated with higher lactate dehydrogenase (LDH) levels at recurrence (mean LDH: 237.2 U/L in recurrent cases vs. 183.2 U/L in nonrecurrent; p=0.01) and smoking history (mean pack-years: 9.10 vs. 4.83; p=0.02). Analysis of tumor staging showed significant differences between recurrent and nonrecurrent groups across all T-stages (p=0.005).

Through logistic regression, the study identified five symptoms strongly associated with recurrence: appetite change, tiredness, lymph node enlargement, abdominal pain, and shortness of breath. These findings were encapsulated in the mnemonic 'ATLAS' (Appetite change, Tiredness, Lymph node enlargement, Abdominal pain, and Shortness of breath). Adjusted odds ratios (ORs) for recurrence included: appetite/fatigue/weight loss (OR, 2.70; 95% confidence interval [CI], 1.37–5.75; p=0.003), dyspnea or cough (OR, 8.11; 95% CI, 2.33–51.26; p=0.002), and gastrointestinal symptoms (OR, 4.07; 95% CI, 1.32–17.83).

The study's retrospective design and variability in follow-up durations were acknowledged limitations. However, the researchers suggested that the 'ATLAS' model could potentially be integrated into current CM surveillance protocols to improve recurrence detection. They recommended future studies validate the findings in diverse populations while accounting for additional risk factors such as tumor ulceration and nodular histology.

Full disclosures can be found in the published study.