Melanoma is a serious form of skin cancer that develops from pigment-producing cells called melanocytes. When caught early, melanoma is highly treatable. But melanoma is dangerous because it can spread quickly to other parts of the body if not removed in time.
One of the biggest concerns for melanoma survivors is the risk of recurrence. Recurrence is when the melanoma comes back after treatment. So does melanoma always recur? Here is a quick look at the recurrence rates and prognosis for melanoma.
What is the recurrence rate for melanoma?
The likelihood of melanoma recurring depends on the stage of the original melanoma tumor. Melanoma is staged from 0 to IV based on thickness and extent of spread. Here are the general recurrence rates by melanoma stage:
- Stage 0: Very low, less than 10%
- Stage I: 20% to 30%
- Stage II: 40% to 50%
- Stage III: 50% to 70%
- Stage IV: Almost 100% if not treated with targeted therapy or immunotherapy
As you can see, the higher the stage at original diagnosis, the greater the chance that melanoma will return after treatment. But even stage 0 or I melanoma can sometimes recur.
What are the chances of recurrence after 5 years?
The five year mark is considered an important milestone for assessing recurrence risk. Research shows:
- Stage 0: Less than 10% chance of recurrence after 5 years
- Stage I: Less than 20% chance of recurrence after 5 years
- Stage II: Up to 30% chance of recurrence after 5 years
- Stage III: Up to 60% chance of recurrence after 5 years
- Stage IV: Over 90% chance of recurrence after 5 years if not given immunotherapy or targeted therapy
So even though the chances decrease after 5 years, there is still a risk of melanoma coming back. Patients with stage III and IV disease remain at high risk of recurrence even after 5 years.
Does melanoma spread before it recurs locally?
Melanoma does not always recur in the same spot first. In fact, melanoma is most likely to recur first at distant sites in the body before coming back locally. This is because melanoma can spread via the bloodstream early on.
When melanoma spreads it is called metastatic melanoma. Metastatic melanoma can recur in places like the lymph nodes, lungs, liver, brain, and bones. Local recurrence happens when melanoma comes back in the skin near the original site.
Patterns of melanoma recurrence
Research shows that melanoma recurrence follows certain patterns depending on the stage:
- Stage I-II: Tend to first recur distant rather than locally. Most common sites are lymph nodes, lungs, liver.
- Stage III: Also more likely to recur first at distant sites. Brain is a common metastatic site.
- Stage IV: Usually recurs systemically throughout the body.
So in summary, melanoma usually spreads via the lymphatic system and bloodstream well before recurring locally. Distant mets usually develop before local recurrence.
What are the chances melanoma will come back after being removed?
The likelihood of melanoma recurring after being surgically removed depends on multiple factors:
Breslow thickness
The Breslow thickness measures how deeply melanoma has invaded into the skin. The thicker the melanoma tumor, the higher the risk of recurrence:
- Less than 1 mm thick: 10-15% recurrence
- 1 to 2 mm thick: 20-30% recurrence
- 2 to 4 mm thick: 30-50% recurrence
- Over 4 mm thick: 50-70% recurrence
Ulceration
Ulceration is when melanoma breaks through the epidermis and causes skin ulceration. Ulcerated melanoma has a higher recurrence rate of up to 50%.
Mitotic rate
The mitotic rate measures how rapidly melanoma cells are dividing. A higher mitotic rate predicts higher recurrence risk.
Positive margins after surgery
Positive surgical margins mean melanoma cells were present at the edge of the removed tissue. This increases the risk of local recurrence.
Lymph nodes removed
If sentinel lymph node biopsy during surgery is positive for cancer, the risk of recurrence is higher. Positive lymph nodes mean melanoma has already started spreading.
Taking all these factors together, an experienced melanoma doctor can provide an accurate recurrence risk estimate after surgical removal.
Does melanoma recur if caught early?
When diagnosed very early, melanoma has a favorable prognosis with lower chances of recurrence. Research shows:
- Stage 0: Almost zero risk if completely excised with clear margins.
- Stage IA: 10-15% recurrence if less than 1 mm thick.
- Stage IB: Up to 20% recurrence if less than 2 mm thick.
So melanoma caught early and treated properly can have low recurrence rates under 20%. But continued monitoring is needed because there is still a risk of recurrence.
5-year survival rates by stage for early melanoma:
- Stage 0: Almost 100%
- Stage IA: 97%
- Stage IB: 92%
Survival rates decrease with more advanced stage II and III disease:
- Stage IIA: 81%
- Stage IIB: 70%
- Stage IIC: 53%
So early detection gives melanoma patients the best chance of long-term survival and low recurrence risk.
What are the warning signs of recurrent melanoma?
Being aware of the signs of recurrent melanoma is important for catching it early when it is most treatable. Warning signs include:
- New black or brown spots on the skin
- Changes in existing moles such as color, size, shape, elevation, itching or bleeding
- Swollen or firm lymph nodes
- Development of lumps or swelling under the skin
- Unexplained weight loss
- Loss of appetite or feeling full quickly
- Shortness of breath, chronic cough, pneumonia
- Severe or persisting headaches
- Seizures, dizziness, balance problems
- Blood in stool or urine
- Chronic fatigue or feeling rundown
- Numbness or weakness anywhere in the body
- Vision changes
Any new or unexplained symptoms in a melanoma survivor need prompt evaluation. Don’t delay telling your doctor.
Catching recurrence early is critical
The earlier recurrent melanoma is found, the better the prognosis. Treatment is much more effective when melanoma recurrence is localized vs widespread metastatic disease. This makes vigilance and early detection extremely important.
What is the prognosis if melanoma recurs?
The prognosis for recurrent melanoma depends on:
- Timing: Is recurrence caught early or late?
- Location: Where has it recurred locally or at distant sites?
- Extent of metastases: How many areas are affected? How large are the tumors?
- Treatment: What treatment options exist? Immunotherapy, targeted therapy, radiation, chemotherapy, surgery?
In general, isolated local recurrence found early has the most favorable prognosis. Widespread distant metastatic disease found later carries a worse prognosis.
To put some numbers on melanoma recurrence prognosis:
- Local recurrence: Up to 30-50% 10-year survival if caught and treated early when small.
- Isolated single distant metastasis: 20-40% 10-year survival depending on location.
- Multiple distant metastases: 15-25% 10-year survival.
- Brain metastases: 15% 10-year survival.
Modern therapies are improving prognosis. Immunotherapy and targeted drugs can produce long-term remission in metastatic melanoma for years.
What tests detect recurrent melanoma?
Regular monitoring and screening tests are important to catch melanoma recurrence in its earliest stages when it can be more successfully treated. Testing recommendations may include:
Full body skin exams
A complete skin exam by a dermatologist every 3-12 months checks for any suspicious lesions. This may detect local recurrence early.
Sentinel lymph node biopsy
A repeat sentinel lymph node biopsy of the nearby lymph nodes every 6-12 months. If positive, it alerts doctors to treat node metastases before they can progress.
Blood tests
Blood tests every 3-6 months check for elevated LDH levels, which may signal metastases.
Imaging tests
Depending on stage, imaging tests like CT, PET, or MRI scans may be done periodically to check lungs, bones, liver, or brain for metastases.
Melanoma marker blood tests
Specialized blood tests detect melanoma biomarkers. If levels rise, it indicates recurrence worth investigating further.
Talk to your doctor about a customized surveillance plan. With careful monitoring, recurrence can often be detected early when it is most treatable.
Can recurrent melanoma be cured?
There is no cure as such for recurrent melanoma. But long-term remission and good quality of life is possible with proper treatment. Important factors include:
- Detecting recurrence when still localized before major spreading
- Surgically removing limited metastases when possible
- Using immunotherapy drugs like checkpoint inhibitors to stimulate the immune system
- Using targeted therapies to block specific melanoma mutations
- Getting personalized treatment guided by genomic testing of tumor cells
- Adding radiation to help control metastases
While challenging to treat, modern advances are making recurrent melanoma more controllable long-term in many cases. The key is early detection and specialized treatment.
5-year survival rates for recurrent melanoma by stage:
- Localized recurrence: 30-60% survival
- Regional lymph node recurrence: 15-40% survival
- Distant recurrence: 10-25% survival
So with proper surveillance and treatment, even some patients with distant recurrence can survive long term.
Can melanoma recur after 10 years?
Yes, melanoma can still recur even after 10 years, although the chances decrease significantly after that milestone. One study found:
- Stage I: Less than 10% recurrence after 10 years
- Stage II: Up to 15% recurrence after 10 years
- Stage III: Up to 30% recurrence after 10 years
So while late recurrence after 10 years is unlikely, it can still happen, especially in higher stage disease. Lifelong monitoring is recommended.
Risk factors for late melanoma recurrence:
- Thickness over 4 mm
- Presence of ulceration
- High mitotic rate in original tumor
- Lymph node metastases present
- Male gender
- Younger age at diagnosis
Talk to your doctor about whether you require monitoring beyond 10 years based on your particular melanoma characteristics and risk factors.
Can melanoma be cured after recurrence?
While melanoma is not considered to be definitively curable after recurrence, long-term remission and good quality of life is possible. The keys are:
- Early detection of recurrence when lesions are small and localized
- Aggressive treatment with surgery, immunotherapy, targeted therapy, radiation
- Preventing progression of metastases to widespread disease
- Effective control of cancer activity leading to very long remission
In some cases, patients can remain disease-free for 10+ years after treatment for recurrent melanoma. But lifelong monitoring and check-ups remain necessary.
5 and 10-year relative survival rates for localized recurrent melanoma:
- 5 years: 30-60% survival
- 10 years: 20-50% survival
So while recurrent melanoma remains serious, long-term remission is possible when caught and treated early. Discuss your particular prognosis with your oncologist.
Does melanoma recur at the original site?
Melanoma can recur locally at the original skin site after being surgically removed. But local recurrence rates are relatively low. Research indicates:
- Stage I: Less than 10% local recurrence if excised properly
- Stage II: Up to 15% local recurrence risk
- Stage III: Up to 20% local recurrence risk
Local recurrence usually happens within the first 5 years. Risk is increased if surgical margins were positive. Detecting local recurrence early is key.
Warning signs of local recurrence:
- New black or dark brown lesion in or near original scar
- Changes in skin around original site like color, thickness, oozing
- Raised mass or nodule in the skin near original location
- Pain, itching, or redness near original location
Careful monitoring and immediate biopsy of any suspicious skin changes near the original melanoma site are important to detect local recurrence early.
Conclusion
To sum up, melanoma recurrence risk depends greatly on the initial stage, with late stage III and IV disease having up to 70% chance of coming back. While melanoma can still recur after 10 years, the risk decreases over time. Modern therapies are improving prognosis. With vigilant monitoring and early detection of recurrence, long-term survival is possible though lifelong surveillance remains necessary.
| Melanoma Stage | 5-Year Recurrence Rate | 10-Year Recurrence Rate |
|---|---|---|
| Stage 0 | Less than 10% | Less than 10% |
| Stage I | 20-30% | Less than 20% |
| Stage II | 40-50% | Up to 30% |
| Stage III | 50-70% | Up to 30% |
| Stage IV | Over 90% if untreated | Over 90% if untreated |