title: Risk factors related to late metastases in 1,372 melanoma patients disease free more than 10 years.
abstract: In many centers, Stage I-II melanoma patients are considered "cured" after 10 years of disease-free survival and follow-up visits are interrupted. However, melanoma may relapse also later. We retrospectively analyzed a cohort of 1,372 Stage I-II melanoma patients who were disease-free 10 years after diagnosis. The aim of this study was to characterize patients who experienced a late recurrence and to compare them to those who remained disease-free to identify possible predictive factors. Multivariate Cox proportional-hazards regression analyses were carried out to evaluate the influence of different factors on the risk of recurrence. Seventy-seven patients out of 1,372 (5.6%) relapsed, 52 in regional sites and 25 in distant ones. The majority of patients (31 out of 52) experienced late recurrence in regional lymph nodes. Brain and lung were the most common site of single distant recurrence (24% each). Patients with multiple distant metastases showed a brain and lung involvement in, respectively, 40 and 48% of cases. A Cox proportional-hazards regression model analysis showed the independent role of age under 40 years, Breslow thickness >2 mm, and Clark Level IV/V in increasing the risk of Late Recurrence. These patients should be followed-up for longer than 10 years. The pattern of recurrence suggests that melanoma cells can be dormant preferentially in lymph nodes, brain and lung. A particular attention should be reserved to these anatomic sites during the follow-up after 10 years of disease-free.
authors.affiliation: Department of Medical Sciences, Section of Dermatology, University of Turin, Turin, Italy; Department of Medical Sciences, Section of Pathology, University of Turin, Turin, Italy.
authors.forename: Simona
authors.initials: S
authors.lastname: Osella-Abate
authors.forename: Simone
authors.initials: S
authors.lastname: Ribero
authors.forename: Martina
authors.initials: M
authors.lastname: Sanlorenzo
authors.forename: Milena Maria
authors.initials: MM
authors.lastname: Maule
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Richiardi
authors.forename: Franco
authors.initials: F
authors.lastname: Merletti
authors.forename: Carlo
authors.initials: C
authors.lastname: Tomasini
authors.forename: Elena
authors.initials: E
authors.lastname: Marra
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Macripò
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Fierro
authors.forename: Pietro
authors.initials: P
authors.lastname: Quaglino
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000453:epidemiology* / Q000556:secondary*; D002648:Child; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000453:epidemiology* / Q000556:secondary*; D008207:Lymphatic Metastasis; D008297:Male; D008545:Melanoma / Q000453:epidemiology / Q000473:pathology*; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D055815:Young Adult
keywords: dormancy; late metastases; melanoma; pattern of recurrence