Melanoma recurrence patterns shift over time, reshaping surveillance strategy
A study of 2,514 stage IIB/C melanoma patients reveals that recurrence risk varies dramatically depending on how long it's been since surgery, challenging one-size-fits-all monitoring protocols. The findings could let oncologists tailor follow-up care and reduce unnecessary imaging, lowering costs while improving outcomes for intermediate-risk patients.
Originaltitel: Assessment of recurrence risk in stage IIB/C melanoma across time: Implications for stratification and surveillance.
**Tidsberoende recidivmönster omformar övervakning av stadium IIB/C melanom** Metastatisk melanom återkommer oftast inom två år efter operation, men recidivtypen förändras drastiskt över tid — en insikt som förändrar övervakningsstrategier och inköpsöversättningsplaner för onkologiska enheter. Forskare från Hospital of the University of Pennsylvania analyserade 2 514 patienter från 19 centra i fyra länder. Av 675 recidiv uppstod 59 procent innan två år, men andelen fjärrmetastaser steg från 39 procent under det första året till 62 procent mellan två och fem år efter operation. Tjocklek över 4 mm och lymfvaskulär invasion var oberoende riskfaktorer. Denna tidsstratifiering möjliggör anpassad övervakning — intensiverad regional bildning under år ett, därefter fokus på systemisk utredning. Regionala inköpschefer kan således optimera resursallokeringen mellan kirurgisk och onkologisk infrastruktur enligt återfallsrisken över tiden.
9568 Background: Stage IIB/C cutaneous melanoma is associated with high recurrence risk, however stratification of risk in relation to time after surgery has not been comprehensively evaluated. We evaluated recurrence-free survival (RFS) at key time points, stratified by clinicopathologic factors, to identify patients (pts) at higher recurrence risk and personalize postoperative surveillance strategies. Methods: In this multi-institutional, international retrospective cohort study from the Sentinel Lymph Node Working Group database, we included pts with pathologic T3b/T4a/T4b and N0 disease who underwent surgical resection and sentinel node biopsy from 1994-2025. The type of first recurrence (local, regional, distant) was characterized based on time category (0-12, 12-24, 24-60, and 60+ months after surgery). Restricted mean survival time (RMST) analysis was used to measure the average survival time up to a specified time point (6-, 12-, 24-, and 60-months after surgery), and associations of clinicopathologic variables (age, sex, Breslow thickness, ulceration and lymphovascular invasion [LVI]) with RFS. Results: We included 2514 stage IIB/C pts from 19 sites in 4 countries, with a median follow-up of 53 (stage IIB) and 49 (stage IIC) months. 675 (27%) pts experienced a recurrence (92 [14%] local, 238 [35%] regional and 345 [51%] distant), and 400 (59%) recurrences occurred within 24 months. The proportion of distant recurrences as the first recurrence increased significantly with time, comprising 39%, 50%, 62%, and 59% of recurrences in the 0-12, 12-24, 24-60, and 60+ month time categories respectively (χ 2 p<0.001). No significant differences were observed for the included clinicopathologic variables for 6-month RMST estimates. At 12 months, RMST estimates for thickness ≥4 mm (11.2 vs 11.6 months for thickness 2-3.99 mm, p<0.001) and presence of LVI (10.7 vs 11.4 months, p=0.009) were significantly different. 24-month RMST estimates differed for male sex (20.7 vs 21.5 months vs females, p=0.002), thickness ≥4 mm (20.5 vs 21.9 months, p<0.001), and presence of LVI (19.0 vs 21.1 months, p<0.001). Lastly, 60-month RMST estimates differed for male sex (42.0 vs 45.2 months, p=0.001), thickness ≥4 mm (41.5 vs 46.2 months, p<0.001), LVI (36.0 vs 43.7 months, p<0.001), and age >65 years (41.5 vs 46.4 for age <42, p=0.022). Conclusions: In this real-world, multi-center analysis of pathologic stage IIB/C melanoma pts, recurrence patterns varied based on time after surgery. Breslow thickness, LVI, male sex, and age were significantly associated with earlier recurrence at different time intervals on RMST analysis. Additionally, given that >50% of first recurrences 12+ months after surgery were distant, active surveillance for distant relapses may be warranted.