Clinical and Pathologic Factors in Stage I and II Melanoma Recurrence

Importance: Localized melanomas account for the highest proportion of melanoma deaths; however, few studies have assessed factors associated with risk of recurrence of localized melanomas. Objective: To determine the clinical and pathologic factors associated with the risk of melanoma recurrence for localized (stage IA to IIC) melanomas. Design, Setting, and Participants: Results of this study suggest that factors in addition to melanoma ulceration and thickness provide an important guide for patient surveillance and counseling about potential recurrence. Participants were individuals diagnosed with stage IA to IIC melanomas from 2010 to 2017. Patients with more than 1 melanoma diagnosed during this time frame, whose index melanomas were recurrences, and whose melanomas were noncutaneous were excluded (125 melanomas). Data were analyzed from January 1 to March 15, 2025. Main Outcomes and Measures: The presence or absence of melanoma recurrence and time to melanoma recurrence. Results: In 1092 patients with melanoma diagnosed from 2010 to 2017, the median age at the time of diagnosis was 60 (range, 0-96) years; most patients were male (57.0% [622]); race and ethnicity categories were Hispanic (4.1% [45]), non-Hispanic (94.4% [1031]), White (96.7% [1056]), other (3.3% [36]), and unknown (1.5% [16]). Multivariable analysis identified 6 variables significantly associated with time to recurrence: ulceration (hazard ratio [HR], 3.48; 95% CI, 2.51-4.82; P < .001), thickness (HR, 1.09; 95% CI, 1.05-1.13; P < .001), tumor location on the scalp or neck (HR, 3.22; 95% CI, 1.94-5.37; P < .001) or face (HR, 2.14; 95% CI, 1.29-3.53; P = .003) compared with the arms, neurotropism (HR, 1.96; 95% CI, 1.03-3.72; P = .04), lymphovascular invasion (HR, 2.52; 95% CI, 1.00-6.34; P = .049), and mitoses (HR, 3.93; 95% CI, 2.47-6.26; P < .001). Conclusions and Relevance: In this study, for localized melanomas, variables beyond those currently considered standard for staging for survival prognosis were associated with time to melanoma recurrence; consideration of factors beyond thickness and ulceration could be valuable in helping to guide surveillance for recurrences.