Surgery predominates in UK loco-regional melanoma cohort

By Tom Whitfield

A BMC Cancer retrospective cohort of 133 UK patients with loco-regional recurrent melanoma estimated 12-month overall survival at 93.0% (95% CI, 88.9%-97.5%) and median recurrence-free survival at 8.7 months (95% CI, 5.6-14.7 months).

The study included patients diagnosed with loco-regional recurrence between 2014 and 2022. The report on the research is dated Oct. 28, 2026.

The 2026 BMC Cancer paper, "Treatment patterns and clinical outcomes in patients with loco-regional recurrent melanoma in the United Kingdom," examined a recurrence pattern with limited formal guidance and incompletely characterized outcomes, particularly as immunotherapy became increasingly used in the adjuvant setting. Its lead author was A. Pender, and the DOI is 10.1186/s12885-026-17126-4.

Investigators extracted treatment records to establish sequencing, then assessed recurrence-free survival, distant metastasis-free survival and overall survival with Kaplan-Meier methods. The work did not prospectively assign treatment sequences; researchers assembled the cohort retrospectively from diagnoses made during the study window.

The authors did not present the cohort as a trial of a new agent or sequence. Instead, they set out practical questions about who developed this form of recurrence, which treatments followed surgery, and how long patients remained free of recurrence or distant spread.

Which treatments did patients receive?

Surgery emerged as the predominant treatment in the 133-patient cohort. Immunotherapy was also widely used after surgery, which the authors linked to the changing systemic-treatment environment captured during the study period.

The report documents what clinicians used and in what order. It does not compare postoperative immunotherapy with another sequence for recurrence, metastasis or survival outcomes.

The cohort spans diagnoses from 2014 through 2022, a period in which adjuvant immunotherapy use was changing. The authors frame the postoperative immunotherapy findings as a reflection of that evolving systemic-therapy environment, not as evidence of superiority for one sequence.

Who was in the cohort?

Median age at diagnosis was 68 years, and 51.1% of patients were male. For 92.5% of participants, cutaneous melanoma was their first-ever melanoma diagnosis.

The cohort therefore chiefly represented patients whose disease began in the skin before returning locally or regionally. Because the study enrolled patients at recurrence rather than at an initial melanoma diagnosis, its reported outcomes describe this later disease stage.

The study offers a real-world snapshot of a recurrence population whose outcomes were not well characterized. It does not describe all UK melanoma cases; the cohort was assembled around recurrence.

What did the survival endpoints show?

The analysis separated three outcomes: recurrence-free survival, distant metastasis-free survival and overall survival. The 12-month overall survival estimate was 93.0%, with a 95% confidence interval from 88.9% to 97.5%.

Median recurrence-free survival was 8.7 months, with a 95% confidence interval from 5.6 to 14.7 months. The analysis also tracked whether patients developed distant metastases.

During follow-up, 49.0% did not develop a distant metastasis (95% CI, 38.1%-60.8%). Approximately the same proportion did, which the authors described as a substantial risk of distant spread.

The survival numbers describe observed outcomes in one real-world cohort. They do not show that either treatment strategy caused better survival, because the authors limited the work to patterns of care and observed outcomes rather than comparative efficacy.

What can this study establish?

The authors said the work provides "historical context rather than an evaluation of any specific therapy." They also described the retrospective cohort as documenting "patterns of care and observed outcomes during a period when adjuvant immunotherapy use was changing."

Those statements define the study’s role. The authors said it does not establish the efficacy of any particular treatment approach, and the observational design cannot attribute outcome differences to surgery, immunotherapy or their sequence.

Instead, the study characterizes patients with loco-regional recurrent melanoma, records treatment patterns and reports survival across the study’s decade of changing systemic therapy. Its value is descriptive: it shows how this recurrence pattern was managed in the UK during the 2014-2022 window.

Formal treatment guidance for loco-regional recurrence remains limited. The authors consider the findings a benchmark for future research into management, rather than a finished evidence base that settles the sequence of surgery and systemic therapy.

The authors position the cohort as a benchmark for future studies seeking clearer guidance on surgery and systemic-treatment sequencing in loco-regional recurrent melanoma.