title: Prospective evaluation of prognostic indicators for early recurrence of cutaneous melanoma.
abstract: The majority of melanomas are thin lesions with an excellent prognosis; however, significant tumor heterogeneity exists, and a small percentage of patients with early-stage disease may progress to metastatic recurrence. This study aimed to assess whether prognostic factors previously shown to be significant in predicting stage I and stage II melanoma recurrence were consistent in a large prospectively collected patient cohort, and to identify novel prognostic factors associated with early recurrence to inform follow-up protocols. There were 1029 patients with stage I and stage II melanoma included in the analysis, of whom 123 developed a recurrence during follow-up (median 2.13 years). Multivariable analysis identified ulceration, presence of mitoses, Clark level, presence of lymphovascular invasion, and a history of autoimmune disease as factors independently associated with recurrence. These data identified patients with stage I-II melanoma with very low-risk for recurrence: no ulceration, zero mitoses, a low Clark level, no lymphovascular invasion, and possibly no history of autoimmune disease. These patients do not require intensive follow-up: 12 monthly reviews and full skin checks may be appropriate. Ongoing research into prognostic factors for recurrence in early-stage melanoma is important.
authors.affiliation: aDivision of Cancer Surgery bCentre for Biostatistics and Clinical Trials (BaCT), Peter MacCallum Cancer Centre cCancer Epidemiology Centre (CEC), Cancer Council Victoria dDepartment of Surgery, University of Melbourne, Melbourne, Australia.
authors.forename: Julia A H
authors.initials: JA
authors.lastname: Matheson
authors.forename: Luc
authors.initials: L
authors.lastname: Te Marvelde
authors.forename: Sonia
authors.initials: S
authors.lastname: Mailer
authors.forename: David
authors.initials: D
authors.lastname: Speakman
authors.forename: John
authors.initials: J
authors.lastname: Spillane
authors.forename: Michael A
authors.initials: MA
authors.lastname: Henderson
authors.forename: David E
authors.initials: DE
authors.lastname: Gyorki
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001327:Autoimmune Diseases / Q000150:complications; D001808:Blood Vessels / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008207:Lymphatic Metastasis; D042601:Lymphatic Vessels / Q000473:pathology; D008297:Male; D008545:Melanoma / Q000150:complications / Q000556:secondary* / Q000601:surgery; D008875:Middle Aged; D008938:Mitosis; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000150:complications / Q000473:pathology*; D009367:Neoplasm Staging; D009360:Neoplastic Cells, Circulating / Q000473:pathology*; D011446:Prospective Studies; D012307:Risk Factors; D012878:Skin Neoplasms / Q000150:complications / Q000473:pathology* / Q000601:surgery; D012883:Skin Ulcer / Q000209:etiology; D055815:Young Adult