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Cutaneous melanoma: Management of local recurrence

Kenneth K Tanabe, MD
Douglas Tyler, MD
Section Editors
Michael B Atkins, MD
Russell S Berman, MD
Deputy Editor
Michael E Ross, MD


Melanoma is an aggressive neoplasm that can metastasize to virtually any organ of the body. For patients with cutaneous melanoma, the prognosis is related to the location, depth, and other biologic properties of the primary tumor, and the presence or absence of locoregional and distant metastatic disease. Surgery represents the principal treatment modality for primary cutaneous melanoma, and adequate excision is important to lessen the risk of a local recurrence. (See "Initial surgical management of melanoma of the skin and unusual sites" and "Tumor node metastasis (TNM) staging system and other prognostic factors in cutaneous melanoma".)

Local recurrence is defined (albeit somewhat arbitrarily) as tumor regrowth within 2 cm of the surgical scar following definitive excision of a primary melanoma with appropriate surgical margins in order to standardize treatment endpoints in clinical trials [1]. Recurrences that are more than 2 cm from the primary lesion but are not beyond the regional nodal basin are termed in transit metastases [2].

The management of locally recurrent melanoma will be discussed here. The management of in transit metastases is discussed separately. (See "Cutaneous melanoma: In transit metastases".)


Local recurrence potentially can arise as a result of one of several mechanisms. These include:

Incomplete excision of the primary – Local recurrence may be due to incomplete excision of the primary tumor, even in the absence of a "positive surgical margin" in the resection specimen. Sampling error can prevent an accurate analysis of all margins of the surgical specimen. In theory, a wider excision with more generous margins might prevent this form of local recurrence. (See "Initial surgical management of melanoma of the skin and unusual sites", section on 'Cutaneous melanoma'.)

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Literature review current through: Nov 2017. | This topic last updated: Oct 10, 2017.
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  1. Balch CM, Urist MM, Karakousis CP, et al. Efficacy of 2-cm surgical margins for intermediate-thickness melanomas (1 to 4 mm). Results of a multi-institutional randomized surgical trial. Ann Surg 1993; 218:262.
  2. Melanoma of the Skin. In: American Joint Committee on Cancer Staging Manual, 7th, Edge SB, Byrd DR, Compton CC, et al (Eds), Springer, New York 2010. p.325.
  3. Kelly JW, Sagebiel RW, Calderon W, et al. The frequency of local recurrence and microsatellites as a guide to reexcision margins for cutaneous malignant melanoma. Ann Surg 1984; 200:759.
  4. Karakousis CP, Balch CM, Urist MM, et al. Local recurrence in malignant melanoma: long-term results of the multiinstitutional randomized surgical trial. Ann Surg Oncol 1996; 3:446.
  5. Cohn-Cedermark G, Rutqvist LE, Andersson R, et al. Long term results of a randomized study by the Swedish Melanoma Study Group on 2-cm versus 5-cm resection margins for patients with cutaneous melanoma with a tumor thickness of 0.8-2.0 mm. Cancer 2000; 89:1495.
  6. Balch CM, Soong SJ, Smith T, et al. Long-term results of a prospective surgical trial comparing 2 cm vs. 4 cm excision margins for 740 patients with 1-4 mm melanomas. Ann Surg Oncol 2001; 8:101.
  7. León P, Daly JM, Synnestvedt M, et al. The prognostic implications of microscopic satellites in patients with clinical stage I melanoma. Arch Surg 1991; 126:1461.
  8. Dong XD, Tyler D, Johnson JL, et al. Analysis of prognosis and disease progression after local recurrence of melanoma. Cancer 2000; 88:1063.
  9. Brown CD, Zitelli JA. The prognosis and treatment of true local cutaneous recurrent malignant melanoma. Dermatol Surg 1995; 21:285.
  10. Gannon CJ, Rousseau DL Jr, Ross MI, et al. Accuracy of lymphatic mapping and sentinel lymph node biopsy after previous wide local excision in patients with primary melanoma. Cancer 2006; 107:2647.
  11. Evans HL, Krag DN, Teates CD, et al. Lymphoscintigraphy and sentinel node biopsy accurately stage melanoma in patients presenting after wide local excision. Ann Surg Oncol 2003; 10:416.
  12. Yao KA, Hsueh EC, Essner R, et al. Is sentinel lymph node mapping indicated for isolated local and in-transit recurrent melanoma? Ann Surg 2003; 238:743.
  13. Beasley GM, Speicher PJ, Sharma K, et al. Efficacy of: repeat sentinel lymph node biopsy for patients who develop recurrent melanoma. Submitted: Journal of American College of Surgeons 2013.
  14. Sober AJ, Chuang TY, Duvic M, et al. Guidelines of care for primary cutaneous melanoma. J Am Acad Dermatol 2001; 45:579.
  15. Felix EL, Jessup JM, Cohen MH. Severe complications of intralesional BCG therapy in an unsensitized patient. Case report and clinical implications. Arch Surg 1978; 113:893.
  16. Andtbacka RH, Collichio FA, Amatruda T, et al. OPTiM: A randomized phase III trial of talimogene laherparepvec (T-VEC) versus subcutaneous (SC) granulocyte-macrophage colony-stimulating factor (GM-CSF) for the treatment (tx) of unresected stage IIIB/C and IV melanoma (abstract #LBA9008). J Clin Oncol 2013; 31.
  17. Bedikian AY, Richards J, Kharkevitch D, et al. A phase 2 study of high-dose Allovectin-7 in patients with advanced metastatic melanoma. Melanoma Res 2010; 20:218.
  18. Testori A, Faries MB, Thompson JF, et al. Local and intralesional therapy of in-transit melanoma metastases. J Surg Oncol 2011; 104:391.
  19. Hu JC, Coffin RS, Davis CJ, et al. A phase I study of OncoVEXGM-CSF, a second-generation oncolytic herpes simplex virus expressing granulocyte macrophage colony-stimulating factor. Clin Cancer Res 2006; 12:6737.
  20. Senzer NN, Kaufman HL, Amatruda T, et al. Phase II clinical trial of a granulocyte-macrophage colony-stimulating factor-encoding, second-generation oncolytic herpesvirus in patients with unresectable metastatic melanoma. J Clin Oncol 2009; 27:5763.
  21. Andtbacka RH, Kaufman HL, Collichio F, et al. Talimogene Laherparepvec Improves Durable Response Rate in Patients With Advanced Melanoma. J Clin Oncol 2015; 33:2780.
  22. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm469571.htm.
  23. Thompson JF, Agarwala SS, Smithers BM, et al. Phase 2 Study of Intralesional PV-10 in Refractory Metastatic Melanoma. Ann Surg Oncol 2015; 22:2135.