title: Risk factors for the development of locoregional cutaneous metastases as the sole form of recurrence in patients with melanoma.
abstract: BACKGROUND
  While locoregional cutaneous metastases (in transit and satellite) in melanoma have received little attention from researchers to date, they have pathogenic and prognostic features that distinguish them from other forms of locoregional recurrence. Identifying predictors of these metastases would be of great value for their prevention, early diagnosis, and treatment. The aim of this study was to identify the risk factors associated with locoregional cutaneous metastases as the first form of recurrence in the metastatic progression of melanoma.
  
  
  METHODS
  Between 2000 and 2010, we prospectively collected the data of 1327 patients diagnosed with stage I and II melanoma. During follow up, 112 patients (8.4%) developed metastases. Of these, 36 had exclusively locoregional cutaneous metastases. The clinical and histological characteristics of this subgroup were evaluated.
  
  
  RESULTS
  In the univariate analysis, significant predictors were patient age, primary tumor thickness, site, ulceration, mitotic index, and histological type. After multivariate analysis, the independent risk factors were tumor thickness (risk ratio [RR] 5.6; 95% CI: 2.7-11.5) and the location of the primary tumor on the lower limbs (RR 3.4; 95% CI: 1.0-11.5), on the head or neck (RR 4.8; 95% IC: 1.7-13.5), or in acral sites (RR 6.7; 95% IC: 2.2-20.8).
  
  
  CONCLUSIONS
  Patients who have melanomas with a Breslow thickness of more than 2mm located on the lower limbs, head, neck, or acral sites have a higher risk of developing locoregional cutaneous metastases. These findings could be useful in the design of future guidelines for the monitoring and management of melanoma.
authors.affiliation: Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España.
authors.forename: F
authors.initials: F
authors.lastname: Messeguer
authors.forename: A
authors.initials: A
authors.lastname: Agustí-Mejías
authors.forename: V
authors.initials: V
authors.lastname: Traves
authors.forename: V
authors.initials: V
authors.lastname: Alegre
authors.forename: V
authors.initials: V
authors.lastname: Oliver
authors.forename: E
authors.initials: E
authors.lastname: Nagore
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008545:Melanoma / Q000453:epidemiology* / Q000556:secondary*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D011446:Prospective Studies; D012307:Risk Factors; D012878:Skin Neoplasms / Q000453:epidemiology* / Q000473:pathology*