- Design
- Retrospective analysis of a national melanoma registry, 2018–2024
- Population
- 365 patients starting first-line treatment for metastatic melanoma, grouped by original stage
- Primary outcome
- Overall survival after systemic relapse
- Effect
- Median 19.8 months after stage I vs 32.6–60.1 months after stage II–III (P = 0.024)
The Spanish Melanoma Registry analysed 365 patients starting first-line treatment for metastatic melanoma between 2018 and 2024, grouped by the stage of their original primary. Fifty-eight had originally been stage I.
Patients whose melanoma had been stage I relapsed later — a median of 52 months, against 25 to 30 months for stages II and III. But when they did relapse, they more often had three or more metastatic sites, brain metastases and a raised LDH, and their median survival was shorter: about 20 months against 33 to 60 months for the other groups.
The practical implications are about follow-up. Stage I patients are often discharged early or seen infrequently, and their relapses arrive years later, when the patient and clinician may have stopped expecting them. This is a registry of patients who did relapse, so it says nothing about how often stage I relapses — only that, when it happens, it tends to be advanced at presentation. Whether more intensive surveillance would change outcomes is untested.
- Teach stage I melanoma patients self-examination of skin and lymph nodes, and tell them relapse can occur years later.
- Take new headache, focal neurological symptoms or seizures seriously in anyone with a past melanoma, however early its stage.
- Keep a clear route back to the dermatology or oncology team for stage I patients after formal follow-up ends.
- Consider brain imaging at staging when a patient with prior stage I melanoma presents with systemic relapse.
Why it matters
Low-risk patients account for a substantial share of metastatic melanoma and may be the least prepared for it.
Don't overread it
The registry includes only patients who relapsed; it does not show that stage I patients need more intensive scanning.
The statistics, in plain English
Brain metastases at relapse were about four times as likely after stage I (OR 4.02, 95% CI 2.13 to 7.58). The survival confidence interval for stage I is very wide (12 to 55.9 months) because only 58 patients were in that group.
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