ORIGINAL ARTICLE Mitotic rate and subcutaneous involvement are prognostic factors for survival after recurrence in patients with only locoregional skin metastasis as the first site of recurrence from cutaneous melanoma F. Messeguer, † A. Agustı ´-Mejı´as, ‡ V. Traves, § C. Requena, † V. Alegre, ‡ C. Guille ´ n, † V. Oliver, ‡ E. Nagore †, * † Department of Dermatology, Instituto Valenciano de Oncologı´a, Valencia, Spain ‡ Department of Dermatology, Consorcio Hospital General Universitari, Valencia, Spain § Department of Pathology, Instituto Valenciano de Oncologı´a, Valencia, Spain *Correspondence: E. Nagore. E-mail: eduyame@meditex.es Abstract Background Few reports on literature give detailed figures on prognostic factors of locoregional skin recurrence in cutaneous melanoma. Objective The aim of this study was to evaluate clinical and histological prognostic factors following development of locoregional cutaneous metastasis as the only progression site from melanoma. Methods Data from 1327 stage I and II melanoma patients who visited Instituto Valenciano de Oncologı ´a and Consorcio Hospital General Universitario de Valencia from 2000 to 2010 were documented in a prospective manner. During follow up, 112 (8.4%) of them developed recurrent disease. A retrospective analysis revealed a subset of 36 patients with locoregional cutaneous metastases as a first event. Results Significant prognostic factors in the univariate analysis were Breslow thickness, tumor mitotic rate and the presence subcutaneous involvement of the skin metastasis. After multivariate analysis the independent predictive factors for survival after recurrence were tumor mitotic rate (hazard ratio [HR]: 8.6; 95% CI: 1.0–77.2) and subcutaneous involvement of the skin metastasis (HR: 4.3; 95% CI: 1.0–18.5). Conclusion The survival after recurrence of melanoma patients that has relapsed with only locoregional cutaneous metastasis depends on the mitotic rate of the primary tumor and the subcutaneous involvement of the metastasis. Received: 22 June 2011; Accepted 12 January 2012 Conflict of interest None. Introduction Cutaneous melanoma (CM) is among the malignant tumours with the most rapidly increasing incidence rates in Caucasian pop- ulations, and it is known to have a high metastatic potential. 1 One-third of all patients diagnosed with localized primary CM suffer a recurrence during a mean follow-up period of 7 years. 2–4 Approximately 50% of CM patients with metastatic spread initially develop regional lymph node metastases. 5 In the other 50%, the first metastases are satellite or in-transit metastases (about 20%) or immediately distant metastases (about 30%). 3,6 Thus, in about two-thirds of all cases of CM, tumour progression develops primarily as locoregional disease (local recurrence, satellite, in- transit and regional lymph node metastasis). Local recurrence of melanoma at the site of the primary excision may be due to either persistence of incompletely excised primary tumour or metastasis. Satellite metastasis is defined as the development of metastatic nodules within 5 cm of the primary tumour excision scar. In-tran- sit metastasis develops within the metastatic drainage area before the first regional lymph node basin. Satellite and in-transit metas- tasis usually precedes regional lymph node metastases, while development of distant metastasis appears to be an independent event in metastatic spread. 3,7 However, few studies have paid attention to prognostic factors of melanoma patients after first recurrence. 3,4,7–12 Progression is mainly related to the site of recurrence and the tumour burden (number of metastases and involved organs). Besides, clinical and pathologic characteristics of the primary lesion (thickness, location and ulceration), patient age and gender keep their prognostic value in patients with recurrence. 3,7–11 Whether the disease-free interval prior to recur- rence is a prognostic factor is controversial. 4,10,13 Other clinical ª 2012 The Authors JEADV 2012 Journal of the European Academy of Dermatology and Venereology ª 2012 European Academy of Dermatology and Venereology DOI: 10.1111/j.1468-3083.2012.04454.x JEADV