Patterns in progression from early-stage melanoma to late-stage melanoma: implications for survivorship follow-up
Creators: name: Savage, David J
name: Switzer, Benjamin
name: Parikh, Rujul
name: Song, Jung Min
name: Stanek, Carolyn
name: Arbesman, Joshua
name: Kennedy, Lucy Boyce
name: Funchain, Pauline
Publisher: name: Taylor & Francis
Year: 2024
Subjects: Medicine
Cell Biology
Neuroscience
Biotechnology
Mathematical Sciences not elsewhere classified
Developmental Biology
Cancer
Mental Health

description: <b>Aim:</b> This study determined the characteristics of patients with early-stage melanoma (IA-IIA) who later had stage IV recurrence. <b>Patients &amp; methods:</b> We retrospectively examined 880 melanoma patients and identified those who progressed to stage IV disease from an initial early-stage (n = 50). <b>Results:</b> We observed a median latent period of 4 years between early-stage diagnosis and metastatic disease. More patients (54%) developed metastatic disease 4 years or later from the initial diagnosis. 34% had regular dermatology appointments, and 30% had regular oncology follow-up. Lung and brain were the most common metastatic sites. <b>Conclusion:</b> Long term monitoring beyond 4 years and a low threshold for performing symptom-guided imaging, particularly if pulmonary or neurologic symptoms occur, may be prudent after early-stage melanoma diagnosis. Early-stage melanoma has an encouraging five-year survival rate of 94%. However, a higher absolute number of fatal melanomas arise from thin rather than thick melanomas, due to the fact that thin, early-stage melanomas far outnumber melanomas that are initially diagnosed at thicker, more advanced stages. This study aimed to understand how and when patients with early-stage melanomas recur with metastatic disease. We examined the charts of 880 patients with melanoma who received care from oncology at a large academic medical center. We identified 50 patients who were initially diagnosed with early-stage melanoma (Stages IA-IIA) but then developed Stage IV melanoma. We measured time from first diagnosis to metastatic diagnosis, anatomic locations of metastases, if there were any symptoms at the time of metastatic diagnosis, and how patients had been followed after an initial early-stage diagnosis. We observed that half of patients developed metastatic disease more than 4 years after their early-stage diagnosis. In these patients, 34% had regular dermatology appointments, and 30% had regular oncology follow-up. Melanoma spread to the lung and brain most commonly. Shortness of breath and altered cognition were the most common symptoms that brought patients to medical attention at the time of stage IV diagnosis. This study demonstrates that the risk of melanoma recurrence exists even after 4 years for early-stage melanomas. Long-term symptom monitoring may be warranted beyond 4 years. Care providers should consider imaging when symptoms occur with no other explainable cause, especially neurologic changes or shortness of breath. Distant metastases from early-stage melanoma, while infrequent, are clinically meaningful and recurrence patterns have not yet been not fully described. This study derives from a panel of 880 patients with metastatic melanoma in order to describe the timing, presentation and clinical follow-up patterns at the time of recurrence or metastasis after an initial diagnosis of early-stage melanoma. Metastatic disease from early-stage melanoma occurred both early and late, with a majority of metastases observed to have occur after 4 years. Early-stage melanoma metastasized most frequently to lung and brain. Understanding these patterns may aid in surveillance planning and suggests a low threshold for brain and chest imaging in symptomatic patients, even with remote history of early-stage melanoma.