title: Outcomes of patients with local recurrence of cutaneous malignant melanoma: a population-based study.
abstract: BACKGROUND
  The definition of local recurrence of cutaneous malignant melanoma varies. The outcomes of patients with a local recurrence reported in the literature also vary, but the appearance of a local recurrence has generally been considered a negative prognostic sign. Few studies have been population-based thus far.
  
  
  METHODS
  During the period 1976-1997, 3706 patients with cutaneous malignant melanoma (including 575 patients with melanoma in situ) were registered in a population-based regional cancer registry. Local recurrence was defined as a recurrence within the scar or transplant with no signs of regional or distant spread of the disease. Prognostic factors were investigated using univariate and multivariate analytic techniques. The prognostic importance of a local recurrence in terms of survival was analyzed using the Cox proportional hazards regression model, with local recurrence as a time-dependent covariate.
  
  
  RESULTS
  Local recurrence as a first event was rare (occurring in 48 of 3706 patients, or 1.3%). Twenty-eight percent (11 of 39) of the patients with local recurrence of invasive primary melanoma developed distant metastases and subsequently died. Only ulceration had prognostic significance in univariate analysis. A Cox analysis, with melanoma death as the endpoint and local recurrence as a time-dependent covariate, demonstrated a relative risk of 1.3 associated with local recurrence; however, this was not statistically significant (confidence interval, 0.7-2.3).
  
  
  CONCLUSIONS
  In this population-based study, local recurrence was a rare event. The outcomes after diagnosis were relatively favorable. The results did not indicate a major detrimental effect on survival from the local recurrence per se.
authors.affiliation: Department of Oncology, Radiumhemmet, Karolinska Hospital, Stockholm, Sweden.
authors.forename: G
authors.initials: G
authors.lastname: Cohn-Cedermark
authors.forename: E
authors.initials: E
authors.lastname: Månsson-Brahme
authors.forename: L E
authors.initials: LE
authors.lastname: Rutqvist
authors.forename: O
authors.initials: O
authors.lastname: Larsson
authors.forename: T
authors.initials: T
authors.lastname: Singnomklao
authors.forename: U
authors.initials: U
authors.lastname: Ringborg
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008545:Melanoma / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000453:epidemiology; D011379:Prognosis; D016016:Proportional Hazards Models; D012042:Registries; D012878:Skin Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery