Time course and pattern of first relapse in stage I-II primary cutaneous melanoma: A multivariate analysis of disease-free survival in 3 174 patients followed-up at the Turin Melanoma Centre from 1975 to 2004

Aim. Our aim is to define the trends in the hazard of overall relapse and pattern of the first recurrence as functions of time elapsed from diagnosis and to identify the parameters with independent predictive value on the relapse risk in stage I-II melanoma patients according to the revised AJCC classification. Methods. A total of 3 174 stage I-II melanoma patients diagnosed and prospectively followed-up since 1975 have been reviewed as to disease course over time. Results. A significant increase in the annual hazard of relapse was found for each time interval from stage IA to IIB/IIC in the first follow-up decade. The incidence of late metastases was significantly higher in patients with thicker melanoma than in those with thinner melanoma. Distant relapses showed a low (<1.5%), but constant annual incidence as first site of recurrence. The lower limb location showed a <1% interval incidence of visceral metastases as first site of relapse, irrespectively of the AJCC stage, compared to 4.7% for the other body sites. Multivariate analysis of DFS showed that Breslow thickness, presence of ulceration and a primary location to foot carry an independent unfavourable prognostic significance. Conclusion. The AJCC stage is associated with the incidence and time course behaviour of the first relapse, the primary location mainly to the pattern of the first relapse.