Tas Faruk, Erturk Kayhan
Department of Medical Oncology, Institute of Oncology, University of Istanbul, Istanbul, Turkey.
Melanoma Res. 2017 Apr;27(2):134-139. doi: 10.1097/CMR.0000000000000332.
Nearly one-third of all melanoma patients will experience disease recurrence and the majority of the relapses eventually develop metastatic disease as a consequence of disease progression in the early-stage melanoma patients. As very few number of studies have investigated the natural recurrence history of early-stage cutaneous melanoma at the first relapse, we analyzed the time until recurrence along with the patterns and outcomes of the relapses in this retrospective study. A total of 332 patients who were initially diagnosed with nonmetastatic melanoma and developed recurrence during the disease course and/or follow-up were included in the analysis. Locoregional relapse alone defined regional lymph node metastases, distant skin, subcutaneous, and satellite/in-transit metastases. Nearly half of the primary recurrences were locoregional metastasis alone (50.6%), followed by mixed locoregional and distant metastases (25.9%), and distant metastases alone (23.5%). In terms of distant metastasis, the lung was the most frequently affected site (30.7%), followed by bone (15.7%), liver (13.9%), and brain (10.8%). The time intervals for each of the recurrence patterns and distant metastasis sites were identical and nearly 16 months. Nearly two-thirds of the relapses occurred within the first 2 years of diagnosis. A significant survival advantage was observed in locoregional relapse alone compared with other relapse patterns (P<0.0001). In conclusion, about half of the melanoma patients developed locoregional relapse alone and it was found to be associated with a favorable prognosis for outcome. Because nearly two-thirds of the relapses occurred within the first 2 years of diagnosis, we suggest that all early-stage melanoma patients should be kept under a strict, thorough, and close follow-up program for at least 2 years following the diagnosis.
近三分之一的黑色素瘤患者会出现疾病复发，由于早期黑色素瘤患者疾病进展，大多数复发最终会发展为转移性疾病。由于很少有研究调查早期皮肤黑色素瘤首次复发时的自然复发史，我们在这项回顾性研究中分析了复发时间以及复发的模式和结果。共有332例最初被诊断为非转移性黑色素瘤且在病程和/或随访期间出现复发的患者纳入分析。仅局部区域复发定义为区域淋巴结转移、远处皮肤、皮下及卫星灶/移行转移。近一半的初次复发仅为局部区域转移（50.6%），其次是局部区域和远处混合转移（25.9%），以及仅远处转移（23.5%）。在远处转移方面，肺是最常受累的部位（30.7%），其次是骨（15.7%）、肝（13.9%）和脑（10.8%）。每种复发模式和远处转移部位的时间间隔相同，接近16个月。近三分之二的复发发生在诊断后的前2年内。与其他复发模式相比，仅局部区域复发观察到显著的生存优势（P<0.0001）。总之，约一半的黑色素瘤患者仅出现局部区域复发，且发现其与良好的预后相关。由于近三分之二的复发发生在诊断后的前2年内，我们建议所有早期黑色素瘤患者在诊断后至少2年内应接受严格、全面和密切的随访。
