Does Melanoma Recur?
After your treatment and despite your doctors’ best efforts, cancer cells do sometimes survive in your body. If melanoma cells survive treatment, multiply enough to form a tumor, and then become visible to the eye, scans, or other tests, your cancer has returned. The medical term for return is recurrence. There is often a lapse in time between treatment for your initial melanoma and the recurrence – this time span can be months or years. The term recurrence is used to describe melanoma that is found after a patient has been treated for the primary melanoma.
Recurrence is different from a new melanoma. A new melanoma is one that appears somewhere on your body that is not related to the original melanoma. This new melanoma is called a new primary melanoma. It is not uncommon to have a second melanoma of the skin due to the same risk factors that caused the first melanoma.
Your doctor will be on the lookout for both types of melanoma—and you should be, too. This page is about recurrence; read here about developing a second melanoma.
The risk of melanoma recurring is generally greater with each stage of melanoma (Stage 0 through IV). Specifically, for primary melanomas, the following factors are important for assessing risk:
- Thickness—thicker tumors are at increased risk for recurrence
- Ulceration—melanoma that was ulcerated or was bleeding or scabbing before it was removed is at higher risk for recurrence
- Satellite metastases—tumors that are surrounded by other tumors are at greater risk
- Mitotic rate—tumors with a high mitotic rate carry greater risk
- Spread to lymph nodes—regional spread carries increased risk
The risk that melanoma will recur after treatment of the first melanoma is grouped into the following categories:
Low risk – less than 20% risk of recurrence
Intermediate risk – 20–50% risk of recurrence
High risk – greater than 50% risk of recurrence.
Your doctor will let you know which category you fall into.
When Does Melanoma Return?
Most recurrences develop in the first two to three years after treatment, but melanoma can recur 10 or more years after it was first treated.
Where Does Melanoma Return?
Melanoma can recur at the original site of the primary melanoma or in the surrounding skin or tissues (called isolated local recurrence); in lymph nodes (called lymph node recurrence); or at other sites in the body (called distant recurrence).
Treatment for Melanoma Recurrence
Isolated Local Recurrence
In this case, a single melanoma reappears in the general area of the original tumor.
Surgery can be used if the site of melanoma can be easily removed. Sometimes medications such as targeted therapy or immune therapy can be used to decrease the size of the lesion or lesions to make surgery easier. In-transit lesions can also be treated with injectable immune therapy such as TVEC or considered for isolated limb perfusion with regional chemotherapy.
Lymph Node Recurrence
In this case, recurrence occurs in the lymph node(s) in the area nearest your primary (original) melanoma.
Recommended treatment depends on the previous type of treatment. Therapeutic lymph node dissection is recommended, and systemic therapy is often warranted after recurrent disease.
Distant Recurrence
Treated the same way as Stage IV melanoma: immunotherapy, targeted therapy, and/or radiation therapy.