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Early Recurrence in Completely Resected IIIB and IIIC Melanoma Warrants Restaging Prior to Adjuvant Therapy

Martine Bloemendal MD, Wouter W. van Willigen MD, Kalijn F. Bol MD, PhD, Marye J. Boers-Sonderen MD, PhD, Johannes J. Bonenkamp MD, PhD, J. E. M. Werner MD, Erik H. J. G. Aarntzen MD, PhD, Rutger H. T. Koornstra MD, PhD, Jan Willem B. de Groot MD, PhD, I. Jolanda M. de Vries PhD, Jacobus J. M. van der Hoeven MD, PhD, Winald R. Gerritsen MD, PhD, Johannes H. W. de Wilt MD, PhD
Melanoma
Volume 26, Issue 12 / November , 2019

Abstract

Purpose

To evaluate the results of restaging completely resected stage IIIB/C melanoma prior to start of adjuvant therapy.

Patients and Methods

One hundred twenty patients with stage IIIB or IIIC (AJCC 2009) melanoma who underwent complete surgical resection were screened for inclusion in our trial investigating adjuvant dendritic cell therapy (NCT02993315). All patients underwent imaging to exclude local relapse or metastasis before entering the trial. The frequency of recurrent disease within 12 weeks after resection and the method of detection were investigated.

Results

Sixty-nine (58%) stage IIIB and 51 (43%) stage IIIC melanoma patients were screened. Median age was 54 (range 27–79) years. Twenty-two (18%) of 120 patients with completely resected stage IIIB/C melanoma had evidence of early recurrent disease, despite exclusion thereof by prior imaging. Median interval between resection and detection of relapse was 7.4 (range 4.3–10.7) weeks. Recurrence was asymptomatic in 17 (77%) patients, but metastasis was noticed by the patient or physician in 5 (23%). Eight patients with local relapse received local treatment with curative intent, and one was treated with systemic therapy. The remaining patients had distant metastasis, 1 of whom underwent resection of a solitary liver metastasis while 12 patients received systemic treatment.

Conclusions

Patients with completely resected stage IIIB/C melanoma have high risk of early recurrence before start of adjuvant therapy. Restaging should be considered for high-risk melanoma patients before start of adjuvant therapy.

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