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ISSN 0210-5187 (Electronic)

2004, Number 3

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Med Cutan Iber Lat Am 2004; 32 (3)

Local Recurrent Melanoma: The Importance of Differentiate Between the True Type and the Metastatic Type

Marinia , Saponaro AE, Casas JG, Remorino ML

Language: Spanish
References: 24
Page: 103-110
PDF size: 546.82 Kb.


ABSTRACT

Local cutaneous recurrent malignant melanoma is the tumoral reappearance within 5 cm of the excisional primary melanoma scar, without signs of regional or distant spread of the disease.
It’s very important to recognize the two types of local recurrence, because they have different implications in patient prognosis and treatment:
1.-True local recurrent melanoma, as a therapeutic failure like inadequate or incomplete excision of the primary melanoma.
2.-Metastatic local recurrent melanoma due either to satellite or in-transit metastases, which came into the 5 cm due to surgical margins (both are cutaneous locoregional metastases).
In most studies we observe ambiguous definitions of local recurrence, so it’s difficult to find statistical rates. The interval between treatment and local recurrence is almost 5 years. The incidence range from 2 to 7%.
In true local recurrent melanoma, the most important risk of recurrence is the surgical margin of insufficient breadth. Recurrent tumors may be seen within or contiguous with the scar, bearing an in situ component by microscopic examination. Face and neck lentigo maligna such as acral lentiginous melanoma, are the most frequent primary melanomas. The prognosis is good and the excision of the entire old scar including a 2 cm margin of normal surrounding tissue is recommended.
Metastatic local recurrent melanoma is related to the thickness of the primary tumor (greater thickness, greater risk). The recurrence is seen adjacent to the scar, with dermal or subcutaneous melanoma but without junctional activity. The prognosis is poor and immunochemotherapy may be the treatment. As true metastases, surgical excision is not often indicated (only to take away the tumoral mass).
The 9 patients of this study show us the clinical and pathological characteristics of the different types of local cutaneous recurrent malignant melanoma.
Three patients presented with true local recurrent melanoma due to insufficient lateral margins of the primary excision (radial extention).
Two patients developed metastatic local recurrent melanoma with satellite lesions. Other case may be either one of this last condition or a deep recurrence of melanoma, following incomplete removal subsequent to insufficient deep margin (vertical extention).
The remaining two patients developed in-transit metastases. These cases with distant cutaneous metastases occurring inside and beyond the 5 cm from the scar and the regional lymph nodes, must be eliminate as local recurrence.


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