Certain factors may impact the risk of cancer coming back.
“Melanoma is not a typical cancer in any way, shape, or form,” says Jeffrey Weber, MD, PhD, medical oncologist and melanoma researcher at Perlmutter Cancer Center at NYU Langone Health. “Depending on how thick it is, and how many different qualities it has, it can have a very high risk of relapse, even after the surgeon takes it out.”
Compared to other skin cancers, melanoma is the most likely to metastasize, or spread to other parts of the body beyond the skin, and this can make it difficult to eradicate all cancer cells.
For metastatic melanoma, doctors will use surgical excision to cut out the visible melanoma tumor and adjuvant therapy to treat melanoma within the body. Newer types of adjuvant therapies, such as immunotherapy and targeted therapy, have been more effective at killing cancer cells in patients with metastatic melanoma. Adjuvant therapy “prolongs the time to return the tumor, it reduces the risk of relapse, [and] it clearly prolongs the survival of the patient,” says Dr. Weber.
Unfortunately, some cancer cells may survive the treatment, and over time they may multiply and develop into a new tumor, according to the American Academy of Dermatology (AAD). This new melanoma growth is a recurrence.
How Common Is Recurrent Melanoma?
Recurrence of melanoma is mostly likely within the first five years after treatment, according to the AAD. Beyond 10 years, it is much less likely for melanoma to recur, but there have been instances of recurrence after as much as 25 years (but this is not common).
A 2013 study by the American College of Surgeons found that melanoma recurrence after 10 years affects about 6 percent of patients. The study also found that those who had recurrence after 10 years were likely to live longer than those who experienced melanoma recurrence within the first three years.
Risk Factors for Melanoma Recurrence
“Patients who have a familial history of melanoma are automatically at a higher risk [for] getting melanoma,” says Kaveh Alizadeh, MD, melanoma surgeon. “If you combine that with the environmental impact of increased sun exposure, that puts you at a higher risk.”
As mentioned before, recurrent melanoma is more likely if the cancer has metastasized. This means melanoma has spread to lymph nodes and possibly other organs, and metastasis is a marker of advanced or stage IV melanoma. Once melanoma affects the lymph nodes, it can more easily spread throughout the body (and is more difficult for treatment to target effectively).
In addition to metastasis, certain melanoma features may also increase the risk of recurrence, such as if the melanoma:
- Is thick (greater than 4 mm)
- Is ulcerated (like a bleeding, open sore)
- And/or is surrounded by other melanomas.
Preventing Melanoma Recurrence
Catching melanoma early and removing it via surgical excision immediately is one of the best ways to prevent melanoma recurrence. “You can dramatically improve your rate of clearing the cancer if you go ahead with the excision in the first 30 days after the diagnosis,” says Dr. Alizadeh.
Nothing can completely guarantee prevention of melanoma recurrence. Certain lifestyle habits, such as wearing sunscreen and eating a healthy diet, may help keep the body and immune system strong to help fight possible recurrence. Learn more tips to reduce the risk of melanoma recurrence.
Attending your regular follow-up appointments after melanoma treatment and doing skin self-checks are two crucial habits for melanoma survivors. Catching melanoma early—whether recurring or the first time—helps improve treatment outcomes.
00:00:02,332 --> 00:00:05,905
Melanoma is not a typical
cancer in any way, shape or form,,
00:00:05,905 --> 00:00:09,917
depending on how thick it is and
how many different qualities it has.
00:00:09,917 --> 00:00:14,512
It can have a very high risk of relapse,
even after the surgeon takes it out.
00:00:14,512 --> 00:00:21,100
00:00:21,100 --> 00:00:25,656
Patients who have a familial history
of melanoma are automatically at
00:00:25,656 --> 00:00:28,445
a higher risk factor of getting melanoma.
00:00:28,445 --> 00:00:32,207
And if you combine that with
the environmental impact of increased sun
00:00:32,207 --> 00:00:34,512
exposure, that puts you at a higher risk.
00:00:34,512 --> 00:00:38,834
And if you have multiple lesions
that have been managed where they're
00:00:38,834 --> 00:00:41,105
sort of moving at different rates and
00:00:41,105 --> 00:00:45,734
at different times, it becomes more
difficult to follow these over time.
00:00:45,734 --> 00:00:50,053
This is a skin cancer that can actually
go up to the border of the skin.
00:00:50,053 --> 00:00:54,931
And at times when it goes beyond
the basement of the skin level,
00:00:54,931 --> 00:00:57,520
it can then potentially spread.
00:00:57,520 --> 00:00:59,161
That's when it's called metastatic.
00:00:59,161 --> 00:01:03,091
Because now, it's left the skin level and
it can enter the nodes.
00:01:03,091 --> 00:01:07,600
And once it goes beyond that node,
it can actually go to other organs and
00:01:07,600 --> 00:01:10,360
that's when it becomes
a distant metastasis.
00:01:10,360 --> 00:01:14,344
Metastasis, meaning that it's spread
beyond the area where it was originally
00:01:14,344 --> 00:01:15,360
seen or diagnosed.
00:01:15,360 --> 00:01:20,070
So it's important to understand
that you can essentially
00:01:20,070 --> 00:01:23,923
cure the patient who has
a lesion in their skin.
00:01:23,923 --> 00:01:28,885
In fact, studies have shown that you
can dramatically improve your rate of
00:01:28,885 --> 00:01:33,767
clearing the cancer if you go ahead
with the excision within the first 30
00:01:33,767 --> 00:01:35,595
days after the diagnosis.
00:01:35,595 --> 00:01:40,477
So adjuvant therapy is what we add
after surgery to decrease the chance that
00:01:40,477 --> 00:01:42,879
that tumor will return or relapse and
00:01:42,879 --> 00:01:46,146
it clearly prolongs the time
to return as a tumor.
00:01:46,146 --> 00:01:49,207
It reduces the risk of relapse or
return as a tumor.
00:01:49,207 --> 00:01:52,637
And then in one case, it clearly
prolongs the survival of the patient.
00:01:52,637 --> 00:01:55,944
95% of all the relapses will
have occurred by year five.
00:01:55,944 --> 00:02:00,299
And in year five, you feel like you're
pretty close to being out of the woods and
00:02:00,299 --> 00:02:02,190
you just gotta go about your life.
00:02:02,190 --> 00:02:09,832
Cutaneous melanoma: management of local recurrence. Waltham, MA: UpToDate, 2019. (Accessed on March 4, 2019 at https://www.uptodate.com/contents/cutaneous-melanoma-management-of-local-recurrence.)
Living as a melanoma skin cancer survivor. Atlanta, GA: American Cancer Society. (Accessed on March 4, 2019 at https://www.cancer.org/cancer/melanoma-skin-cancer/after-treatment/follow-up.html.)
Melanoma frequently asked questions. Seattle, WA: Virginia Mason Medical Center. (Accessed on March 4, 2019 at https://www.virginiamason.org/melanoma-faqs#13.)
Melanoma recurs after 10 years in more than 6 percent of patients. Chicago, IL: American College of Surgeons, 2013. (Accessed on March 4, 2019 at https://www.facs.org/media/press-releases/jacs/melanoma0613.)
Your best defense vs. another melanoma. Schaumburg, IL: American Academy of Dermatology. (Accessed on March 4, 2019 at https://www.aad.org/public/diseases/skin-cancer/melanoma/your-best-defense-against-another-melanoma.)