{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T14:24:16Z","timestamp":1783347856929,"version":"3.54.6"},"reference-count":25,"publisher":"Springer Science and Business Media LLC","issue":"8","license":[{"start":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T00:00:00Z","timestamp":1779753600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T00:00:00Z","timestamp":1779753600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100012287","name":"Andrew Sabin Family Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100012287","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100002224","name":"Melanoma Research Foundation","doi-asserted-by":"publisher","award":["Career Development Award"],"award-info":[{"award-number":["Career Development Award"]}],"id":[{"id":"10.13039\/100002224","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006098","name":"Radiological Society of North America","doi-asserted-by":"publisher","award":["Scholar Award"],"award-info":[{"award-number":["Scholar Award"]}],"id":[{"id":"10.13039\/100006098","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Ann Surg Oncol"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>The presence of microsatellites in cutaneous melanoma has historically been associated with a poor prognosis. Whether adjuvant primary site radiation therapy (RT) mitigates risk of recurrence is unknown.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>All patients with cutaneous melanoma who underwent primary site wide local excision at our center between 2016 and 2023 with histopathologic evidence of microsatellites and no clinically involved lymph nodes, in-transit disease, or macrosatellites were retrospectively reviewed. We investigated the association of patient, disease, and treatment factors with recurrence and survival outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      We identified 153 eligible patients with microsatellites. With a median follow-up of 31 months from resection, 3-year local recurrence-free survival (LRFS) was 78% and 3-year disease-free survival (DFS) was 42%. The majority received adjuvant systemic therapy (55%, n = 85 immune checkpoint inhibition; 5%, n = 7 BRAF\/MEK-directed therapy). Fifty-nine patients (39%) received postoperative RT after wide local excision. On multivariate analyses with inverse propensity score weighting, receipt of adjuvant primary site RT was associated with longer local recurrence-free survival (LRFS, hazard ratio 0.22,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.04), which appears to drive longer disease-free survival (DFS, hazard ratio 0.46,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.007).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In the contemporary therapeutic era, even with the majority of patients receiving adjuvant immune checkpoint inhibition or targeted therapy, adjuvant RT is associated with higher local control and DFS. Patients with microsatellitosis should be referred for consideration of postoperative RT.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1245\/s10434-026-19819-3","type":"journal-article","created":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T13:40:22Z","timestamp":1779802822000},"page":"7461-7470","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Role of Adjuvant Primary Site Radiotherapy for Cutaneous Melanoma Patients with Microsatellitosis"],"prefix":"10.1245","volume":"33","author":[{"given":"Anjali","family":"Devireddy","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yifan","family":"Yi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelsey N.","family":"Nordlund","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruitao","family":"Lin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aya","family":"Salem","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noel X.","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sydney","family":"Keatts","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oriana","family":"Jerez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahsan","family":"Farooqi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew J.","family":"Bishop","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B. Ashleigh","family":"Guadagnolo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Priyadharsini","family":"Nagarajan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roi","family":"Weiser","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah B.","family":"Fisher","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan","family":"Goepfert","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Merrick I.","family":"Ross","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rodabe N.","family":"Amaria","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabella C. Glitza","family":"Oliva","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alison K.","family":"Yoder","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Devarati","family":"Mitra","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,5,26]]},"reference":[{"key":"19819_CR1","doi-asserted-by":"publisher","unstructured":"Day CL, Harrist TJ, Gorstein F, et al. Malignant melanoma. Prognostic significance of \u201cmicroscopic satellites\u201d in the reticular dermis and subcutaneous fat. Ann Surg. 1981;194(1):108-12. https:\/\/doi.org\/10.1097\/00000658-198107000-00019","DOI":"10.1097\/00000658-198107000-00019"},{"issue":"10","key":"19819_CR2","doi-asserted-by":"publisher","first-page":"2183","DOI":"10.1002\/1097-0142(19840515)53:10<2183::AID-CNCR2820531029>3.0.CO;2-9","volume":"53","author":"TJ Harrist","year":"1984","unstructured":"Harrist TJ, Rigel DS, Day CL, et al. \u201cMicroscopic satellites\u201d are more highly associated with regional lymph node metastases than is primary melanoma thickness. Cancer. 1984;53(10):2183\u20137.","journal-title":"Cancer."},{"issue":"12","key":"19819_CR3","doi-asserted-by":"publisher","first-page":"1461","DOI":"10.1001\/archsurg.1991.01410360031006","volume":"126","author":"P Le\u00f3n","year":"1991","unstructured":"Le\u00f3n P, Daly JM, Synnestvedt M, Schultz DJ, Elder DE, Clark WH. The prognostic implications of microscopic satellites in patients with clinical stage I melanoma. Arch Surg. 1991;126(12):1461\u20138. https:\/\/doi.org\/10.1001\/archsurg.1991.01410360031006.","journal-title":"Arch Surg."},{"issue":"2","key":"19819_CR4","doi-asserted-by":"publisher","first-page":"338","DOI":"10.1016\/j.jaad.2022.10.027","volume":"88","author":"CRM Loughlin","year":"2023","unstructured":"Loughlin CRM, Sandoval-Clavijo A, de Tord MB, et al. Prognostic role of microsatellites in melanoma and implications in the American Joint Committee on Cancer classification system: A cohort study. Journal of the American Academy of Dermatology. 2023;88(2):338\u201347. https:\/\/doi.org\/10.1016\/j.jaad.2022.10.027.","journal-title":"Journal of the American Academy of Dermatology."},{"key":"19819_CR5","doi-asserted-by":"crossref","unstructured":"Green FL, Page DL, Fleming ID, et al. AJCC cancer staging manual. 6th edition. Springer-Verlag; 2002.","DOI":"10.1007\/978-1-4757-3656-4"},{"issue":"3","key":"19819_CR6","doi-asserted-by":"publisher","first-page":"1016","DOI":"10.1245\/s10434-013-3388-5","volume":"21","author":"EK Bartlett","year":"2014","unstructured":"Bartlett EK, Gupta M, Datta J, et al. Prognosis of patients with melanoma and microsatellitosis undergoing sentinel lymph node biopsy. Ann Surg Oncol. 2014;21(3):1016\u201323. https:\/\/doi.org\/10.1245\/s10434-013-3388-5.","journal-title":"Ann Surg Oncol."},{"issue":"6","key":"19819_CR7","doi-asserted-by":"publisher","first-page":"739","DOI":"10.1001\/archderm.141.6.739","volume":"141","author":"L Shaikh","year":"2005","unstructured":"Shaikh L, Sagebiel RW, Ferreira CMM, Nosrati M, Miller JR, Kashani-Sabet M. The role of microsatellites as a prognostic factor in primary malignant melanoma. Arch Dermatol. 2005;141(6):739\u201342. https:\/\/doi.org\/10.1001\/archderm.141.6.739.","journal-title":"Arch Dermatol."},{"issue":"7","key":"19819_CR8","doi-asserted-by":"publisher","first-page":"1369","DOI":"10.1038\/s41379-020-0500-9","volume":"33","author":"MG Niebling","year":"2020","unstructured":"Niebling MG, Haydu LE, Lo SN, et al. The prognostic significance of microsatellites in cutaneous melanoma. Mod Pathol. 2020;33(7):1369\u201379. https:\/\/doi.org\/10.1038\/s41379-020-0500-9.","journal-title":"Mod Pathol."},{"issue":"6","key":"19819_CR9","doi-asserted-by":"publisher","first-page":"747","DOI":"10.1097\/00000658-198412000-00015","volume":"200","author":"JW Kelly","year":"1984","unstructured":"Kelly JW, Sagebiel RW, Calderon W, Murillo L, Dakin RL, Blois MS. The frequency of local recurrence and microsatellites as a guide to reexcision margins for cutaneous malignant melanoma. Ann Surg. 1984;200(6):747.","journal-title":"Ann Surg."},{"issue":"19","key":"19819_CR10","doi-asserted-by":"publisher","first-page":"1789","DOI":"10.1056\/NEJMoa1802357","volume":"378","author":"AMM Eggermont","year":"2018","unstructured":"Eggermont AMM, Blank CU, Mandala M, et al. Adjuvant Pembrolizumab versus Placebo in Resected Stage III Melanoma. New England Journal of Medicine. 2018;378(19):1789\u2013801. https:\/\/doi.org\/10.1056\/NEJMoa1802357.","journal-title":"New England Journal of Medicine."},{"issue":"19","key":"19819_CR11","doi-asserted-by":"publisher","first-page":"1824","DOI":"10.1056\/NEJMoa1709030","volume":"377","author":"J Weber","year":"2017","unstructured":"Weber J, Mandala M, Del Vecchio M, et al. Adjuvant nivolumab versus ipilimumab in resected stage III or IV melanoma. N Engl J Med. 2017;377(19):1824\u201335. https:\/\/doi.org\/10.1056\/NEJMoa1709030.","journal-title":"N Engl J Med."},{"issue":"19","key":"19819_CR12","doi-asserted-by":"publisher","first-page":"1813","DOI":"10.1056\/NEJMoa1708539","volume":"377","author":"GV Long","year":"2017","unstructured":"Long GV, Hauschild A, Santinami M, et al. Adjuvant dabrafenib plus trametinib in stage III BRAF-mutated melanoma. N Engl J Med. 2017;377(19):1813\u201323. https:\/\/doi.org\/10.1056\/NEJMoa1708539.","journal-title":"N Engl J Med."},{"issue":"10336","key":"19819_CR13","doi-asserted-by":"publisher","first-page":"1718","DOI":"10.1016\/S0140-6736(22)00562-1","volume":"399","author":"JJ Luke","year":"2022","unstructured":"Luke JJ, Rutkowski P, Queirolo P, et al. 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\u201329. https:\/\/doi.org\/10.1016\/S0140-6736(22)00562-1.","journal-title":"Lancet."},{"issue":"6","key":"19819_CR14","doi-asserted-by":"publisher","first-page":"688","DOI":"10.1001\/jamadermatol.2019.0440","volume":"155","author":"LA von Schuckmann","year":"2019","unstructured":"von Schuckmann LA, Hughes MCB, Ghiasvand R, et al. Risk of melanoma recurrence after diagnosis of a high-risk primary tumor. JAMA Dermatology. 2019;155(6):688\u201393. https:\/\/doi.org\/10.1001\/jamadermatol.2019.0440.","journal-title":"JAMA Dermatology."},{"key":"19819_CR15","doi-asserted-by":"publisher","unstructured":"Perez MC, Tanabe KK, Ariyan CE, et al. Local and recurrent regional metastases of melanoma. Cutaneous Melanoma. Published online August 22, 2019:705-737. https:\/\/doi.org\/10.1007\/978-3-030-05070-2_24","DOI":"10.1007\/978-3-030-05070-2_24"},{"issue":"1","key":"19819_CR16","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1016\/j.hoc.2018.09.005","volume":"33","author":"RI Hartman","year":"2019","unstructured":"Hartman RI, Lin JY. Cutaneous melanoma-a review in detection, staging, and management. Hematol Oncol Clin North Am. 2019;33(1):25\u201338. https:\/\/doi.org\/10.1016\/j.hoc.2018.09.005.","journal-title":"Hematol Oncol Clin North Am."},{"issue":"6","key":"19819_CR17","doi-asserted-by":"publisher","first-page":"1607","DOI":"10.3390\/jcm13061607","volume":"13","author":"AJ Dixon","year":"2024","unstructured":"Dixon AJ, Sladden M, Zouboulis CC, et al. Primary cutaneous melanoma-management in 2024. J Clin Med. 2024;13(6):1607. https:\/\/doi.org\/10.3390\/jcm13061607.","journal-title":"J Clin Med."},{"issue":"1","key":"19819_CR18","doi-asserted-by":"publisher","first-page":"26","DOI":"10.1097\/00000637-199201000-00009","volume":"28","author":"CW Cruse","year":"1992","unstructured":"Cruse CW, Wells KE, Schroer KR, Reintgen DS. Etiology and prognosis of local recurrence in malignant melanoma of the skin. Ann Plast Surg. 1992;28(1):26\u20138. https:\/\/doi.org\/10.1097\/00000637-199201000-00009.","journal-title":"Ann Plast Surg."},{"issue":"11","key":"19819_CR19","doi-asserted-by":"publisher","first-page":"1538","DOI":"10.1038\/modpathol.2017.76","volume":"30","author":"AHR Varey","year":"2017","unstructured":"Varey AHR, Goumas C, Hong AM, et al. Neurotropic melanoma: an analysis of the clinicopathological features, management strategies and survival outcomes for 671 patients treated at a tertiary referral center. Mod Pathol. 2017;30(11):1538\u201350. https:\/\/doi.org\/10.1038\/modpathol.2017.76.","journal-title":"Mod Pathol."},{"issue":"9","key":"19819_CR20","doi-asserted-by":"publisher","first-page":"1369","DOI":"10.1002\/cncr.28412","volume":"120","author":"T Strom","year":"2014","unstructured":"Strom T, Caudell JJ, Han D, et al. Radiotherapy influences local control in patients with desmoplastic melanoma. Cancer. 2014;120(9):1369\u201378. https:\/\/doi.org\/10.1002\/cncr.28412.","journal-title":"Cancer."},{"issue":"4","key":"19819_CR21","doi-asserted-by":"publisher","first-page":"1051","DOI":"10.1016\/j.ijrobp.2006.05.056","volume":"66","author":"DT Chang","year":"2006","unstructured":"Chang DT, Amdur RJ, Morris CG, Mendenhall WM. Adjuvant radiotherapy for cutaneous melanoma: comparing hypofractionation to conventional fractionation. Int J Radiat Oncol Biol Phys. 2006;66(4):1051\u20135. https:\/\/doi.org\/10.1016\/j.ijrobp.2006.05.056.","journal-title":"Int J Radiat Oncol Biol Phys."},{"key":"19819_CR22","doi-asserted-by":"publisher","unstructured":"Pinkham MB, Herschtal A, Hong AM, et al. Randomized trial of postoperative radiation therapy after wide excision of neurotropic melanoma of the head and neck (RTN2 Trial 01.09). Ann Surg Oncol. 2024;31(9):6088-96. https:\/\/doi.org\/10.1245\/s10434-024-15569-2","DOI":"10.1245\/s10434-024-15569-2"},{"issue":"14","key":"19819_CR23","doi-asserted-by":"publisher","first-page":"1345","DOI":"10.1056\/NEJMoa1709684","volume":"377","author":"JD Wolchok","year":"2017","unstructured":"Wolchok JD, Chiarion-Sileni V, Gonzalez R, et al. Overall survival with combined nivolumab and ipilimumab in advanced melanoma. N Engl J Med. 2017;377(14):1345\u201356. https:\/\/doi.org\/10.1056\/NEJMoa1709684.","journal-title":"N Engl J Med."},{"issue":"9","key":"19819_CR24","doi-asserted-by":"publisher","first-page":"1361","DOI":"10.1002\/cncr.28415","volume":"120","author":"BA Guadagnolo","year":"2014","unstructured":"Guadagnolo BA, Prieto V, Weber R, Ross MI, Zagars GK. The role of adjuvant radiotherapy in the local management of desmoplastic melanoma. Cancer. 2014;120(9):1361\u20138. https:\/\/doi.org\/10.1002\/cncr.28415.","journal-title":"Cancer."},{"key":"19819_CR25","doi-asserted-by":"publisher","unstructured":"Riaz N, Leong SP, Kashani-Sabet M, et al. Prognostic value of non-nodal regional metastases in predicting sentinel lymph node status in cutaneous melanoma: multicenter analysis of the sentinel lymph node working group database. Ann Surg Oncol. Published online January 23, 2026. https:\/\/doi.org\/10.1245\/s10434-026-19086-2","DOI":"10.1245\/s10434-026-19086-2"}],"container-title":["Annals of Surgical Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1245\/s10434-026-19819-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1245\/s10434-026-19819-3","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1245\/s10434-026-19819-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T13:42:27Z","timestamp":1783345347000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1245\/s10434-026-19819-3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,26]]},"references-count":25,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2026,8]]}},"alternative-id":["19819"],"URL":"https:\/\/doi.org\/10.1245\/s10434-026-19819-3","relation":{},"ISSN":["1068-9265","1534-4681"],"issn-type":[{"value":"1068-9265","type":"print"},{"value":"1534-4681","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,26]]},"assertion":[{"value":"8 January 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"5 May 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"26 May 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Isabella Glitza Oliva BMS: research support to institution, advisory board. MERCK: research support to institution. Pfizer: research support to institution, advisory board.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Disclosure"}}]}}