title: Hazard rates for recurrent and secondary cutaneous melanoma: an analysis of 33,384 patients in the German Central Malignant Melanoma Registry.
abstract: BACKGROUND
  Knowledge about the risk for recurrence and secondary cutaneous melanoma (CM) is an important basis for patient counseling and planning of follow-up examinations.
  
  
  OBJECTIVE
  This study aimed to analyze stage- and time-dependent hazard rates (HR) and discusses current surveillance recommendations.
  
  
  METHODS
  Follow-up data of 33,384 patients with incident CM in stages I to III (American Joint Committee on Cancer 2002) were recorded by the German Central Malignant Melanoma Registry in 1976 through 2007. Survival was based on Kaplan-Meier estimates and HRs were calculated.
  
  
  RESULTS
  Recurrences were recorded in 4999 patients (stage I, 7.1%; stage II, 32.8%; and stage III, 51.0%). Ten-year recurrence-free survival was 78.9% (95% confidence interval 73.1-90.5); in stage I, 89.0%; stage II, 56.9%; and stage III, 36.0%. Whereas HR for recurrent CM showed a constantly low level less than or equal to 1:125 per year for stage IA, clearly higher HRs of greater than or equal to 1:40 were recorded in stage IB for the first 3 years and generally in stages II to III. Of all patients 2.3% developed secondary melanomas, with a consistently low HR of less than 1:220 per year.
  
  
  CONCLUSIONS
  As German recommendations discontinued regular follow-up examinations after 10 years, no information can be given beyond this time point. Follow-up data of longer than 5 years were available in 41.4% of patients.
  
  
  CONCLUSIONS
  For patients at stage IA with thin melanoma and low HR for recurrent CM the need for surveillance remains questionable. For patients with higher HR greater than 1:40 per year, intensified surveillance strategies should be taken into account.
authors.affiliation: Center for Dermato-Oncology, Department of Dermatology, Eberhard Karls University, Tübingen, Germany.
authors.forename: Ulrike
authors.initials: U
authors.lastname: Leiter
authors.forename: Petra G
authors.initials: PG
authors.lastname: Buettner
authors.forename: Thomas K
authors.initials: TK
authors.lastname: Eigentler
authors.forename: Eva B
authors.initials: EB
authors.lastname: Bröcker
authors.forename: Christiane
authors.initials: C
authors.lastname: Voit
authors.forename: Harald
authors.initials: H
authors.lastname: Gollnick
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Marsch
authors.forename: Uwe
authors.initials: U
authors.lastname: Wollina
authors.forename: Friedegund
authors.initials: F
authors.lastname: Meier
authors.forename: Claus
authors.initials: C
authors.lastname: Garbe
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008545:Melanoma / Q000175:diagnosis / Q000473:pathology / Q000556:secondary*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000473:pathology*; D016016:Proportional Hazards Models; D012307:Risk Factors; D012878:Skin Neoplasms / Q000175:diagnosis / Q000473:pathology*