Patterns and Timing of Initial Relapse in Pathologic Stage II Melanoma Patients.
OBJECTIVE
Pathologic stage II melanoma patients have variable outcomes when divided by substage. We hypothesized that an understanding of the patterns of initial relapse by substage will better inform follow-up guidelines.


METHODS
We performed a retrospective review of 738 adult patients with pathologic stage II cutaneous melanoma treated at Memorial Sloan Kettering Cancer Center between 1993 and 2013. Clinical records were reviewed to determine time, location, and method of detection of initial relapse.


RESULTS
At a median follow-up of 52 months, 219 patients relapsed. Relapses were detected more frequently in higher substages. Initial relapses were most commonly local/in-transit for IIA and IIB and systemic for IIC. Lung and brain were the most frequent sites of systemic relapse. Patient-detection was the most common method of relapse detection (59%) in all substages. The 5-year cumulative incidence for patient-detected relapse was 13.6% for IIA, 18.9% for IIB, and 23.3% for IIC and for image-detected relapse was 3.4, 7.9, and 16.6%, respectively. The 5-year cumulative incidence for physician-detected relapse was less than 10% across all substages and leveled off at 3 years for stage IIA and IIB and 2 years for stage IIC.


CONCLUSIONS
Relapses were most frequently patient-detected in all stage II substages, highlighting the importance of patient education and self-examination. The highest yield for routine imaging is in stage IIC patients during the first 4 years. Physician examination is unlikely to detect relapses beyond 3 years for stage IIA and IIB and beyond 2 years for stage IIC patients.
Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.|New York University School of Medicine, New York, NY, USA.
Ann Y
AY
Lee
Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.|Catholic University of Chile School of Medicine, Santiago, Chile.
Nicolas
N
Droppelmann
Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Katherine S
KS
Panageas
Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Qin
Q
Zhou
Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Charlotte E
CE
Ariyan
Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Mary S
MS
Brady
Department of Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Paul B
PB
Chapman
Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA. coitd@mskcc.org.
Daniel G
DG
Coit
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000150:complications / Q000000981:diagnostic imaging* / Q000556:secondary; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications / Q000000981:diagnostic imaging* / Q000556:secondary; D008207:Lymphatic Metastasis; D008297:Male; D008545:Melanoma / Q000175:diagnosis / Q000556:secondary* / Q000601:surgery; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis*; D009367:Neoplasm Staging; D010353:Patient Education as Topic; D010819:Physician's Role; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D016353:Self-Examination; D012878:Skin Neoplasms / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery; D013997:Time Factors; D055815:Young Adult