title: Factors affecting survival following local, regional, or distant recurrence from localized melanoma.
abstract: OBJECTIVE
  Approximately one third of all melanoma patients will experience disease recurrence. Factors that affect patient survival following local, regional, or distant first recurrences of localized melanoma are the subject of this investigation.
  
  
  METHODS
  Survival times for a total of 1,085 first recurrences from 4,568 localized melanoma patients were examined in relationship to patient and disease factors by Cox regression. Nearly half (48.8%) of all first recurrences were regional, 21.8% were local, and 29.4% were distant recurrences.
  
  
  RESULTS
  Survival following recurrence differed significantly by site of recurrence (local, regional, or distant; P < 0.0001). Within each site, the median survival time did not differ by time of recurrence following diagnosis. Significant tumor factors for survival following local recurrence included tumor thickness (P = 0.0263) and lesion location (P < 0.0001). For regional recurrences, survival was significantly related to ulceration (P = 0.0105) and whether the recurrence was combined with a local recurrence (P = 0.0429). Survival following distant metastasis was related to number of distant sites (P < 0.0001) and whether a visceral site was involved (P < 0.0001).
  
  
  CONCLUSIONS
  Patient and tumor characteristics predict survival following recurrence. Regardless of disease-free interval, long-term follow-up of melanoma patients is necessary. Patients experiencing distant metastasis have the shortest median survival time compared to patients experiencing local or regional recurrences.
authors.affiliation: Biostatistics Unit, University of Alabama at Birmingham, 35294-3300, USA. soong@lue.biosccc.uab.edu
authors.forename: S J
authors.initials: SJ
authors.lastname: Soong
authors.forename: R A
authors.initials: RA
authors.lastname: Harrison
authors.forename: W H
authors.initials: WH
authors.lastname: McCarthy
authors.forename: M M
authors.initials: MM
authors.lastname: Urist
authors.forename: C M
authors.initials: CM
authors.lastname: Balch
mesh_terms: D018572:Disease-Free Survival; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis; D008545:Melanoma / Q000401:mortality* / Q000556:secondary*; D015999:Multivariate Analysis; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local / Q000401:mortality*; D011379:Prognosis; D016016:Proportional Hazards Models; D016019:Survival Analysis