title: Patient Symptoms Are the Most Frequent Indicators of Recurrence in Patients with American Joint Committee on Cancer Stage II Melanoma.
abstract: BACKGROUND
  Patients with stage II melanoma have a considerable risk for recurrence. Current guidelines are imprecise as to optimal follow-up. We hypothesized that by examining recurrence patterns, we could help to better inform guidelines.
  
  
  METHODS
  We queried IRB-approved melanoma databases of Thomas Jefferson University and University of North Carolina, identifying 581 patients with stage II melanoma between 1996 and 2015 with at least 1 year of follow-up. Data included location of first recurrence and how recurrence was detected (ie patient symptom, physician examination, or routine surveillance imaging). Cox regression with backward elimination was used for multivariable analysis.
  
  
  RESULTS
  One hundred and seventy-one patients had a recurrence (29.4%), the incidence increased considerably by stage sub-group. Significant predictors of recurrence included male sex (p = 0.003), ulceration (p = 0.03), and stage (p < 0.001). On multivariable analysis, male sex and stage continued to be significant (p < 0.01). For overall survival, regression, ulceration, stage, and age were significant predictors of survival. Stage, regression, and age remained significant by multivariable analysis. Patient symptoms were the most frequent mode of detection (40%), followed by physician examination (30%) and surveillance imaging (26%)-this did not differ significantly by stage. Regional nodes were the most common site of recurrence (30%), followed by lung (27%) and in-transit (18%).
  
  
  CONCLUSIONS
  The majority of recurrences in stage II melanoma are detected by patients and their physicians and rarely by routine imaging. As such, clinical follow-up and patient education are critical factors in detection of recurrence. With the prevalence of regional nodal recurrences, ultrasound might prove to be an important strategy in early recurrence detection.
authors.affiliation: Department of Surgery, Thomas Jefferson University, Philadelphia, PA. Electronic address: adam.berger@jefferson.edu.
authors.forename: Adam C
authors.initials: AC
authors.lastname: Berger
authors.affiliation: Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA.
authors.forename: David W
authors.initials: DW
authors.lastname: Ollila
authors.affiliation: Department of Surgery, Thomas Jefferson University, Philadelphia, PA.
authors.forename: Adrienne
authors.initials: A
authors.lastname: Christopher
authors.affiliation: Department of Surgery, Thomas Jefferson University, Philadelphia, PA.
authors.forename: John C
authors.initials: JC
authors.lastname: Kairys
authors.affiliation: Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Mastrangelo
authors.affiliation: Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA.
authors.forename: Kendra
authors.initials: K
authors.lastname: Feeney
authors.affiliation: Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA.
authors.forename: Nooreen
authors.initials: N
authors.lastname: Dabbish
authors.affiliation: Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Leiby
authors.affiliation: Department of Surgery, University of North Carolina, Chapel Hill, NC.
authors.forename: Jill A
authors.initials: JA
authors.lastname: Frank
authors.affiliation: Department of Surgery, University of North Carolina, Chapel Hill, NC.
authors.forename: Karyn B
authors.initials: KB
authors.lastname: Stitzenberg
authors.affiliation: Department of Surgery, University of North Carolina, Chapel Hill, NC.
authors.forename: Michael O
authors.initials: MO
authors.lastname: Meyers
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008545:Melanoma / Q000401:mortality / Q000473:pathology*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis*; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D055815:Young Adult