{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T14:33:04Z","timestamp":1792506784169,"version":"4.5.0"},"reference-count":27,"publisher":"American Medical Association (AMA)","issue":"11","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Dermatol"],"published-print":{"date-parts":[[2023,11,1]]},"abstract":"<jats:sec id=\"ab-doi230044-4\">\n                    <jats:title>Importance<\/jats:title>\n                    <jats:p>\n                      To ensure optimal treatment and surveillance of patients with melanoma, knowledge of the clinical stage-specific risk of recurrence, mortality, and recurrence patterns across the\n                      <jats:italic>American Joint Committee on Cancer Eighth Edition<\/jats:italic>\n                      (\n                      <jats:italic>AJCC8<\/jats:italic>\n                      ) substages is needed.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-doi230044-5\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To estimate stage-specific recurrence and melanoma-specific mortality rates, assess absolute stage-specific risks of recurrence and mortality, and describe stage-specific recurrence patterns, including conditional rates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-doi230044-6\">\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Retrospective cohort study of prospectively collected nationwide population-based registry data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-doi230044-7\">\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Nationwide, population-based cohort study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-doi230044-8\">\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>The 25\u202f720 Danish patients, 18 years or older, diagnosed with first-time stage IA to IV cutaneous melanoma between January 1, 2008, and December 31, 2019, were included and followed up from time of primary treatment until December 31, 2021.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-doi230044-9\">\n                    <jats:title>Exposures<\/jats:title>\n                    <jats:p>First diagnosis of stage IA to IV cutaneous melanoma.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-doi230044-10\">\n                    <jats:title>Main Outcomes<\/jats:title>\n                    <jats:p>Stage-specific cumulative incidence of recurrence and melanoma-specific mortality, melanoma-specific recurrence-free survival, and assessed absolute stage-specific risks of recurrence and melanoma-specific mortality. Secondary outcomes were stage-specific recurrence patterns, including conditional rates, and melanoma-specific survival.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-doi230044-11\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We followed up 25\u202f720 patients for a median of 5.9 years (95% CI, 58.9-59.3 years). Mean age was 59.1 years (95% CI, 58.9-59.3 years). Patients with stage IIB to IIC melanoma were older, had more comorbidities at diagnosis, and had the lowest rate of pathologic staging by sentinel node biopsy (81.6%-87.4%). A total of 10.6% of patients developed recurrence; first recurrence included distant recurrence, alone or with synchronous locoregional recurrence, in 56.6% of patients. We found a comparable risk of recurrence in stages IIIA and IIB (29.7% vs 33.2%) and in stages IIIB and IIC (35.9% vs 36.8%), respectively. Melanoma-specific mortality was comparable between stages IIIA and IIA (13.0% vs 13.6%) and between stages IIIB and IIB (18.4% vs 22.0%), respectively. These risk patterns persisted in cause-specific hazards models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-doi230044-12\">\n                    <jats:title>Conclusions and Relevance<\/jats:title>\n                    <jats:p>\n                      This nationwide, population-based cohort study found that the increasing stages of the current\n                      <jats:italic>AJCC8<\/jats:italic>\n                      staging system do not accurately reflect an increasing risk of recurrence and mortality in melanoma. The high proportion of distant recurrences suggests that hematogenous spread is a more common metastatic pathway than previously assumed, and surveillance with routine functional\/cross-sectional imaging should be considered for stages IIB to IV. Future efforts should be put toward developing new tools for risk stratification and determining the survival effect of routine imaging in surveillance.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1001\/jamadermatol.2023.3256","type":"journal-article","created":{"date-parts":[[2023,8,31]],"date-time":"2023-08-31T08:30:33Z","timestamp":1693470633000},"page":"1213","source":"Crossref","is-referenced-by-count":84,"title":["Stage-Specific Risk of Recurrence and Death From Melanoma in Denmark, 2008-2021"],"prefix":"10.1001","volume":"159","author":[{"given":"Neel M.","family":"Helvind","sequence":"first","affiliation":[{"name":"Department of Plastic Surgery, Copenhagen University Hospital: Herlev and Gentofte, Herlev, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie","family":"Brinch-M\u00f8ller Weitemeyer","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, Copenhagen University Hospital: Herlev and Gentofte, Herlev, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annette H.","family":"Chakera","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, Copenhagen University Hospital: Herlev and Gentofte, Herlev, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helle W.","family":"Hendel","sequence":"additional","affiliation":[{"name":"Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital: Herlev and Gentofte, Herlev, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva","family":"Elleb\u00e6k","sequence":"additional","affiliation":[{"name":"National Center for Cancer Immune Therapy, Copenhagen University Hospital: Herlev and Gentofte, Herlev, Denmark"},{"name":"Department of Oncology, Copenhagen University Hospital: Herlev and Gentofte, Herlev, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Inge Marie","family":"Svane","sequence":"additional","affiliation":[{"name":"National Center for Cancer Immune Therapy, Copenhagen University Hospital: Herlev and Gentofte, Herlev, Denmark"},{"name":"Department of Oncology, Copenhagen University Hospital: Herlev and Gentofte, Herlev, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mette W.","family":"Kj\u00e6rskov","sequence":"additional","affiliation":[{"name":"Department of General and Plastic Surgery, Vejle Hospital, Vejle, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sophie","family":"Bojesen","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, Zealand University Hospital Roskilde, Roskilde, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helle","family":"Skyum","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, Aalborg University Hospital, Aalborg, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S\u00f8ren K.","family":"Petersen","sequence":"additional","affiliation":[{"name":"Department of Oncology, Odense University Hospital, Odense, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lars","family":"Bastholt","sequence":"additional","affiliation":[{"name":"Department of Oncology, Odense University Hospital, Odense, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoffer","family":"Johansen","sequence":"additional","affiliation":[{"name":"Cancer Late Effect Research, Oncology Clinic, Center for Surgery and Cancer, Rigshospitalet, Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pernille E.","family":"Bidstrup","sequence":"additional","affiliation":[{"name":"Psychological Aspects of Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisbet R.","family":"H\u00f6lmich","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, Copenhagen University Hospital: Herlev and Gentofte, Herlev, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"6","key":"doi230044r1","doi-asserted-by":"publisher","first-page":"472","DOI":"10.3322\/caac.v67.6","article-title":"Melanoma staging: Evidence-based changes in the American Joint Committee on Cancer eighth edition cancer staging manual.","volume":"67","author":"Gershenwald","year":"2017","journal-title":"CA Cancer J Clin"},{"issue":"22","key":"doi230044r2","doi-asserted-by":"publisher","first-page":"2543","DOI":"10.1200\/JCO.19.03034","article-title":"Prognosis of patients with stage III melanoma according to American Joint Committee on Cancer Version 8: a reassessment on the basis of 3 independent stage III melanoma cohorts.","volume":"38","author":"Garbe","year":"2020","journal-title":"J Clin 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C, Keim? U, Amaral? T, . Prognosis of patients with primary melanoma stage I and II according to American Joint Committee on Cancer Version 8 validated in two independent cohorts: implications for adjuvant treatment.? J Clin Oncol. 2022;40(32):3741-3749. doi:10.1200\/JCO.22.00202?","DOI":"10.1200\/JCO.22.00202"},{"key":"doi230044r4","doi-asserted-by":"crossref","unstructured":"Luke? JJ, Rutkowski? P, Queirolo? P, . Pembrolizumab versus placebo as adjuvant therapy in completely resected stage IIB or IIC melanoma (KEYNOTE-716): a randomised, double-blind, phase 3 trial.? Lancet. 2022;399(10336):1718-1729. doi:10.1016\/S0140-6736(22)00562-1?","DOI":"10.1016\/S0140-6736(22)00562-1"},{"key":"doi230044r16","unstructured":"R Core Team. R: a language and environment for statistical computing. R Foundation for Statistical Computing. 2022. Accessed January 15, 2022. https:\/\/www.r-project.org\/"},{"key":"doi230044r27","unstructured":"Danish Melanoma Group. Dansk Melanoma Database. 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