The Risk of Recurrence

When melanoma comes back after it has been treated, it is called a recurrence. Recurrent melanoma may appear locally (at or near the site of the original primary melanoma tumor) or in another part of the body. This is not the same as developing a new primary melanoma that is unrelated to first primary melanoma. (See below, “Developing a Second Melanoma”)

The probability that the primary melanoma will recur after appropriate treatment is characterized as low-risk, intermediate-risk, or high-risk.

  • Low-risk: less than 20% risk of recurrence
  • Intermediate-risk: 20% to 50% risk of recurrence
  • High-risk:  greater than 50% risk of recurrence. High-risk melanoma has a high probability of having already spread to local or distant sites at the time of treatment.

The risk of recurrence of your primary melanoma increases with:

  • The thickness of the primary melanoma, with thicker tumors carrying greater risk than thin tumors
  • The presence of ulceration in the primary melanoma
  • The presence of satellite metastases surrounding the primary melanoma
  • The presence of an increased mitotic rate in the primary tumor

Recurrences can occur at the original site of the primary melanoma or in the surrounding skin or tissues, in lymph nodes or at other sites in the body including internal organs.

Treatment for recurrent melanoma is determined by the location and number of sites of melanoma, as well as other factors. Treatments may include surgery, radiation or systemic therapies.

Developing A Second Melanoma

If you have had melanoma in the past, you are at increased risk for developing a new primary melanoma. A significant number of patients with a past history of melanoma develop a second primary melanoma after a period of time.

  • A study reviewing the data of 3310 patients with Stage I and Stage II melanoma revealed a 2.8% risk of developing a second melanoma after five years and a 3.6% risk after 10 years. (1)

Screening for a melanoma recurrence as well as new primary melanomas through skin self-examination and regular medical skin examination is of the utmost importance. Sun/UV protection and avoidance is also recommended .

Prognosis for a Second Melanoma

The appearance of a second primary melanoma does not necessarily carry a poor prognosis, and is determined by the stage of the second melanoma tumor.  Research supports the benefits of close physician follow-up and patient education in the early detection of second melanomas.

In one study, the thickness of a second primary melanoma was compared with that of the initial primary tumor. In almost 50% of cases, the second melanoma was significantly thinner than the initial melanoma. (2)  This may be the result of an earlier diagnosis of the secondary primary melanoma, due to the fact that the patient and physician were already performing close monitoring.

Second primary melanomas are treated just like the original primary melanoma, with surgery in the form of a wide local excision and possible additional surgery and treatment, as appropriate.

References:

1. DiFronzo LA, Wanek LA, Elashoff R, Morton DL. Increased Incidence of Second Primary Melanoma in Patients with a Previous Cutaneous Melanoma. Ann Surg Oncol. 1999;6:705-711.
2. DiFronzo LA, Wanek LA, Morton DL. Earlier Diagnosis of Second Primary Melanoma Confirms the Benefits of Patient Education and Routine Postoperative Follow-Up. Cancer. 2001;91:1520-1524.

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