Melanoma Recurrent

Recurrent melanoma means that cancer cells have survived the initial treatment and the disease has returned. Understanding what recurrence means, where it can appear, and how it’s managed is crucial for anyone who has been treated for melanoma.

Table of contents

• What Is Recurrent Melanoma
• Where Melanoma Can Recur
• When Melanoma Returns
• Risk of Recurrence by Stage
• Signs and Symptoms
• Treatment Options
• Importance of Regular Follow-Up
• Reducing the Risk of Recurrence

What Is Recurrent Melanoma

After treatment for melanoma, sometimes cancer cells survive in the body despite doctors’ best efforts. When these melanoma cells survive treatment, they can multiply over time and the cancer returns^[1]. This is called recurrent melanoma.

Recurrent melanoma is melanoma that has come back after the initial treatment. A recurrent melanoma always grows from the original (primary) melanoma cells, even if it appears in a different location from the first cancer^[7].

It’s important to understand that having melanoma once also increases the risk of developing a completely new, separate melanoma. This would be a different primary melanoma rather than a recurrence of the original cancer^[7].

Where Melanoma Can Recur

Recurrent melanoma can develop in the same location as the original melanoma or in other parts of the body. The most common places for melanoma to recur include^[4]:

• On the skin close to where the cancer started, known as satellite tumors
• In nearby lymph vessels, called in-transit metastases
• In the area of the original surgical scar
• In nearby lymph nodes, also called regional or nodal recurrence

When melanoma comes back near the original site or in nearby tissues, this is called locally recurrent melanoma^[4]. However, melanoma can also recur in distant lymph nodes or internal organs, which is considered distant recurrence^[7].

When Melanoma Returns

Most recurrent melanomas develop within two to three years after the removal of the primary melanoma^[7]. However, melanoma can recur more than 10 years after the original treatment. Remaining melanoma-free for over 10 years reduces the risk of recurrent melanoma, but the possibility still exists^[7].

The timing of follow-up care typically reflects this pattern. In the early years after treatment, when the risk is highest, doctors schedule more frequent check-ups. As time passes without a relapse, the frequency of visits gradually decreases^[6].

Risk of Recurrence by Stage

The likelihood of melanoma returning depends heavily on its stage at the time of initial diagnosis and treatment. Lower stage melanomas have a lower risk of recurrence, while the risk increases as the stage advances^[6].

For stage I melanomas, which are considered low risk, more than 90% of patients can be cured^[6]. Stage II melanomas are thicker and deeper in the skin and have a higher risk of recurrence, though there’s no indication that the cancer has spread at diagnosis. Stage III melanomas, which have spread to nearby lymph nodes or skin, carry a higher risk of recurrence^[6].

The chances of recurrence vary by stage. It’s less likely to recur at lower stages. For thicker melanomas or those at more advanced stages, the time frame for follow-up monitoring may be shorter and more intensive^[6].

Signs and Symptoms

The clearest symptom of recurrent melanoma is a new spot or lesion on the skin that is changing. People who have had melanoma should watch for any new or changing marks on their skin^[7].

When looking for signs of melanoma during self-examinations, it’s helpful to remember the ABCDE rule^[6]:

• Asymmetry: One half of the mole or birthmark does not match the other half
• Borders: The edges are irregular, ragged, notched, or blurred
• Color: The color is not uniform and may include shades of brown or black, or patches of pink, red, white, or blue
• Diameter: The spot is larger than the tip of a pencil eraser
• Evolving: The mole is changing in size, shape, or color

New lumps under the skin or changes in skin color should be examined by a doctor. Any new symptoms that do not go away should also be reported to a healthcare provider^[6].

Treatment Options

Treatment for recurrent melanoma depends on several factors, including where the cancer has returned, how much it has spread, and the patient’s overall health. The healthcare team will suggest treatments based on individual needs and work with the patient to develop a treatment plan^[4].

Surgery

Surgery is usually offered for locally recurrent melanoma. A wide local excision, sometimes called surgical resection, removes the tumor on the skin along with a small amount of healthy tissue around it, called the surgical margin^[4].

If melanoma has returned in lymph nodes, a complete lymph node dissection may be performed to remove a group of lymph nodes. The type of lymph node surgery depends on which and how many lymph nodes contain cancer^[4].

In some cases, a skin graft may be needed. This is when the surgeon removes skin from another area of the body and places it over the surgical area to cover the open wound and repair the skin^[4].

Immunotherapy

Immunotherapy helps strengthen or restore the immune system’s ability to fight cancer. It may be offered for locally recurrent melanoma, either after surgery to remove tumors or when there are many tumors that cannot be removed with surgery^[4].

Some immunotherapy drugs are applied directly to the tumor or on the skin as a cream, which is called localized therapy. Other immunotherapy drugs are given systemically, meaning they circulate throughout the body^[4].

Targeted Therapy

Targeted therapy uses drugs to target specific molecules on cancer cells or inside them to stop the growth and spread of cancer. This type of therapy is sometimes offered for recurrent melanoma with certain gene changes or mutations^[4].

Importance of Regular Follow-Up

The main key to managing melanoma recurrence is early detection. After treatment, it’s vital to continue seeing a dermatologist or physician regularly. The frequency of follow-up visits is based on each person’s specific case^[6].

General recommendations suggest seeing a physician every three to six months after melanoma treatment. The higher the stage of melanoma, the higher the risk of relapse, and the more frequent the monitoring^[6].

A typical follow-up schedule might include visits every three months for the first year, then every four to six months for the next year, followed by every six months up to five years. If there is no evidence of disease relapse at that point, follow-up may continue once a year^[6].

During follow-up appointments, healthcare providers perform skin and lymph node examinations to watch for any new melanoma or signs of cancer returning. The stage of melanoma and other individual factors help determine the specific schedule for each person^[6].

Reducing the Risk of Recurrence

While past sun damage is often responsible for recurrences, new damage can also lead to new cancers. The single most important thing people can do to protect their skin is to reduce sun exposure^[17].

Protection from UV Rays

Limiting exposure to ultraviolet (UV) rays is essential. This means avoiding both natural UV rays from the sun and artificial sources such as tanning beds and sun lamps^[6].

The sun’s rays are strongest between 10 a.m. and 4 p.m. If sun exposure during these hours cannot be avoided, protection is necessary. Recommendations include^[6]:

• Using broad-spectrum sunscreen with at least 30 SPF that protects against both UVA and UVB rays
• Wearing sun-protective clothing, including long sleeves and pants
• Wearing a wide-brimmed hat that extends two to three inches to shade the neck, nose, and ears
• Using UV-blocking sunglasses
• Reapplying sunscreen every two hours when outdoors, and after swimming or sweating

Self-Examination

Melanoma survivors should conduct regular self-examinations of their skin. This includes monitoring moles and looking for any irregular or changing spots. If any moles appear irregular or concerning, a physician should be contacted immediately^[6].

A family member can help with self-examinations, especially for areas that are difficult to see^[6].

Healthy Lifestyle

Adopting healthy habits may help reduce the risk of cancer recurrence. This includes not smoking, eating nutritious food, exercising regularly, and maintaining a healthy weight^[16].

Keeping a strong immune system is also important. A weak immune system could leave room for melanoma to come back. Steps to support the immune system include avoiding infections, washing hands regularly, getting adequate sleep, and minimizing stress^[16].