title: Stage I cutaneous malignant melanoma: risk factors of loco-regional recurrence after wide local excision and clinical perspectives.
abstract: Two hundred and nineteen patients admitted to the Centre Claudius Regaud over a 14-year period for a stage I cutaneous malignant melanoma were retrospectively evaluated for loco-regional recurrence rates, risk factors and survival rates following wide primary excision. Five and 8 year survival rates corrected for deaths owing to concurrent illness were 77% and 73%. The loco-regional control rate was 69% (151/219). Distant metastases occurred in 59% (40/68) of patients who had a loco-regional recurrence, versus 11% (16/151) of patients when loco-regional control was obtained (P < 0.001). Multivariate analysis was used to ascertain which risk factors act independently as predictors of poor loco-regional control. Anatomical location of the primary ('head and neck-trunk-hands and feet' vs 'proximal limb') and thickness formed the best model in this respect among 11 prognostic factors studied. Since loco-regional recurrence may be associated with an increased risk of distant metastatic disease, we advocate the use of elective regional lymph node dissection in stage I patients at high risk of loco-regional recurrence in the hope that a portion of these patients may have increased survival owing to lack of development of widespread metastases.
authors.affiliation: Department of Radiotherapy, Centre Claudius Regaud, Toulouse, France.
authors.forename: J M
authors.initials: JM
authors.lastname: Bachaud
authors.forename: R
authors.initials: R
authors.lastname: Shubinski
authors.forename: G
authors.initials: G
authors.lastname: Boussin
authors.forename: C
authors.initials: C
authors.lastname: Chevreau
authors.forename: J M
authors.initials: JM
authors.lastname: David
authors.forename: R
authors.initials: R
authors.lastname: Viraben
authors.forename: J L
authors.initials: JL
authors.lastname: Bonafé
authors.forename: N J
authors.initials: NJ
authors.lastname: Daly
mesh_terms: D000206:Actuarial Analysis; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D008545:Melanoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D015999:Multivariate Analysis; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology*; D009367:Neoplasm Staging; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D012878:Skin Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate