Local and Regional Recurrence Patterns in Patients with Locally Advanced Cutaneous Melanoma: A Retrospective Cohort Study from Brazil

Cutaneous melanoma is associated with a high risk of recurrence in advanced stages, particularly stages IIC and III. In Brazil, limitations in access to specialized follow-up and imaging may influence recurrence detection and outcomes, and data describing local and regional recurrence patterns remain limited. We conducted a retrospective cohort study including 297 patients diagnosed with stage IIC or III cutaneous melanoma treated at Barretos Cancer Hospital, Brazil, between 2000 and 2016. Sociodemographic, clinical, and histopathologic characteristics were analyzed, along with recurrence patterns, methods of detection, and survival outcomes. Disease-free survival (DFS) and cancer-specific survival (CSS) were estimated using Kaplan–Meier methods and compared according to clinical stage and site of first recurrence. During a median follow-up of 18.4 months, disease recurrence occurred in 57.6% of patients. Regional recurrence was the most frequent pattern, followed by distant and local events. Most recurrences were detected through clinical evaluation (67.5%), while imaging, primarily computed tomography (CT), accounted for the remaining diagnoses. The lungs were the most common site of distant recurrence. Patients with stage IIC melanoma demonstrated significantly longer DFS and CSS compared with those diagnosed at stage IIID. Median DFS differed according to the site of first recurrence, with longer intervals observed in patients with distant recurrence compared with local or regional relapse (p = 0.005). Recurrence is frequent among patients with locally advanced melanoma, with local and regional events accounting for a substantial proportion of first relapses. Clinical examination remains the primary method of recurrence detection in this Brazilian cohort, highlighting the need for surveillance strategies adapted to the Brazilian public health system.