title: Prognosis and determinants of outcome following locoregional or distant recurrence in patients with cutaneous melanoma.
abstract: OBJECTIVE
  Information on prognosis for patients with cutaneous melanoma after locoregional or distant recurrence is sparse and controversial. The aim of this study was to analyze factors influencing outcome after the development of a first relapse.
  
  
  METHODS
  Information was extracted from the Sydney Melanoma Unit database for 873 melanoma patients with American Joint Committee on Cancer (AJCC) Stage I and II disease treated between 1960 and 2002 who relapsed following treatment of their primary melanoma. Clinical and pathologic factors predicting survival were analyzed using the Cox proportional hazards regression model.
  
  
  RESULTS
  Initial presentation of recurrence was local: 95 patients (10.9%), in transit: 86 patients (9.9%), regional lymph node: 300 patients (34.4%), and distant: 392 patients (44.9%). Independent prognostic factors for survival of the 481 patients with only locoregional recurrence were type of recurrence, primary tumor ulceration, and patient age. Predictors for longer survival in the 392 patients with distant metastasis at the time of first presentation with recurrence were lung vs other sites and diagnosis of relapse after 1990 compared with diagnosis before 1980.
  
  
  CONCLUSIONS
  The type of recurrence is the most important prognostic factor in melanoma patients who relapse. Primary tumor ulceration is the most important pathologic predictor. The results of this study suggest that management of distant metastases may have improved over the last 25 years, but many confounders and improved staging techniques make assessment of this unreliable.
authors.affiliation: Sydney Melanoma Unit, Sydney Cancer Centre, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.
authors.forename: Anne Brecht
authors.initials: AB
authors.lastname: Francken
authors.forename: Neil A
authors.initials: NA
authors.lastname: Accortt
authors.forename: Helen M
authors.initials: HM
authors.lastname: Shaw
authors.forename: Martin
authors.initials: M
authors.lastname: Wiener
authors.forename: Seng-jaw
authors.initials: SJ
authors.lastname: Soong
authors.forename: Harald J
authors.initials: HJ
authors.lastname: Hoekstra
authors.forename: John F
authors.initials: JF
authors.lastname: Thompson
mesh_terms: D001859:Bone Neoplasms / Q000556:secondary / Q000628:therapy; D001932:Brain Neoplasms / Q000556:secondary / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary / Q000628:therapy; D008175:Lung Neoplasms / Q000556:secondary / Q000628:therapy; D008207:Lymphatic Metastasis; D008297:Male; D008545:Melanoma / Q000556:secondary* / Q000628:therapy; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis*; D011379:Prognosis; D012307:Risk Factors; D012878:Skin Neoplasms / Q000473:pathology* / Q000628:therapy; D015996:Survival Rate; D016896:Treatment Outcome