Dark predictions.

In the spirit of inclusiveness for future adjuvant systemic therapy trials, this large Spanish retrospective review of nearly 1200 patients treated for stage I-II cutaneous melanoma teased out the biggest risk factors for subsequent nodal and distant recurrences. Eventually, 13% developed metastatic disease. The winning predictors for nodal mets were: Breslow thickness >0.4 cm (HR 5.4), presence of vascular invasion (HR 3.2), age > 55 (HR 1.9), or primary site in hands and feet (HR 2.4) or H&N (HR, 1.7). Standout predictors for distant mets were: again Breslow thickness >0.4 cm (HR 10.4), TERT promoter mutations (HR 2.9) and BRAF mutations (HR 1.9), while depigmentation, i.e. “regression,” appeared protective (HR 0.1). TBL: Will it be Merck or Bristol-Myers Squibb to first develop a point system to buy adjuvant immune checkpoint inhibitors for early-stage cutaneous melanoma? | Calomarde-Rees, JAMA Dermatol 2019