Disease Symptoms Are the Most Frequent Indicators of Recurrence in Patients With Stage II Melanoma

Key Points

  • Of 581 patients with stage II melanoma and at least 1 year of follow-up, 171 patients developed a recurrence (29.4%).
  • Male sex, ulceration, and stage were significant predictors of recurrence.
  • Patient symptoms were the most frequent mode of detection, with 40% of recurrences spotted by patients.
  • 30% of recurrent melanomas were identified by scheduled physician exam and 26% by surveillance imaging.

Recurrences of early-stage (stage II) melanoma are more often detected by patients and their physicians than by routine imaging tests, according to study results published by Berger et al in the Journal of the American College of Surgeons.

“We are most concerned about patients who have stage II melanoma,” said study coauthor Adam C. Berger, MD, FACS, Professor of Surgery at Thomas Jefferson University, Philadelphia. “They have more advanced primary melanomas, and on average, between 20% and 45% of these patients will die within 5 years. In the past, we didn’t have good therapies for this type of melanoma, but new therapies mean survival continues to improve.”

In this new study, which covered the years 1996 to 2015, investigators from Thomas Jefferson University and the University of North Carolina analyzed data from a multi-institution database on 581 patients with stage II melanoma and at least 1 year of follow-up. Of those, 171 patients with early-stage melanoma developed a recurrence (29.4%). Male sex, ulceration, and stage were significant predictors of recurrence.

“We wanted to get a breakdown on how we are discovering recurring melanomas,” Dr. Berger said.

The question was whether it was a change a patient observed that warranted a trip to the doctor, a symptom a physician identified during a scheduled visit, or something detected with routine imaging. Study data included place of first recurrence and how recurrence was detected—patient symptom, physician exam, or routine surveillance imaging.

Study Findings

The analysis revealed that patient symptoms were the most frequent mode of detection, with 40% of recurrences spotted by patients, whether it was a suspicious change they felt on their skin or a symptom such as coughing up blood or seizures.

Further, 30% of recurrent melanomas were identified by scheduled physician exam and 26% by surveillance imaging. One reason melanoma is lethal is that it can metastasize rapidly to other organs like the liver or lungs. Regional nodes were the most common site of recurrence (30%), followed by the lungs (27%), and in-transit metastases (18%).

“The fact that imaging picked up 26% of patients with recurrence is notable, because it is a little higher than what we’ve seen in the past, which I think reflects the current trend to do more imaging in general,” Dr. Berger said. “There is a move to use [computed tomography] scans and other imaging techniques as an important strategy in early recurrence detection.”

Very few studies have specifically analyzed recurrence and detection patterns for patients with stage II melanoma. Researchers expect the findings from this study to help reshape protocols for people diagnosed with melanoma. “Our hope is to have some impact on future follow-up guidelines and how we think about screening for recurrent melanoma. Every study like this helps contribute to framing those guidelines,” Dr. Berger said.

Importantly, people who have been previously diagnosed with early-stage melanoma need to be on the alert for symptoms of recurrence.

“Patients need to be aware of all of their symptoms and their body. But it’s also important for physicians to educate patients as to what to look for and what symptoms are a cause for concern,” Dr. Berger said. “Patients should examine their skin and the area where lymph nodes would be on a monthly basis. And if they have a symptom that doesn’t go away after 2 or 3 weeks, it should be brought to a physician’s attention, because that [may be] an indicator that the melanoma has come back.”

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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