OBJECTIVES: Stage IB cutaneous melanomas are characterized by a low risk for recurrence and a high survival. However, empirical evidence on recurrence patterns and survival subsequent to recurrence is limited. We investigated overall survival (OS) and recurrence patterns, and assessed whether the time-to-recurrence was associated with prognostic factors. METHODS: The Dutch Comprehensive Cancer Centers registry was used to identify patients diagnosed with stage IB melanoma between January 2003 and December 2011 in six Dutch hospitals including two academic and four general hospitals (n=971). Data were retrospectively collected using electronic hospital records. Survival was assessed using the Kaplan-Meier estimator. Recurrence patterns were investigated by type of first recurrence and time-to-recurrence. A multivariate cox regression was used to analyze whether time-to-recurrence was associated with gender, age and tumor thickness. Emigrated patients (n=10) and patients with an unknown recurrence status (n=144) were excluded. RESULTS: Of all 817 patients, 111 patients (13.6%) experienced disease progression (median follow-up: 5.5 years). Patients who developed a recurrence had a lower survival compared to patients who did not developed a recurrence (median OS: 9.4 years versus median has not yet been reached; 5-year survival rate: 69.9% versus 96.6%; p<0.001). The most frequent type of first recurrence was lymphatic (36.9%), followed by distant (22.5%), local (21.6%) and intralymphatic (9.9%), respectively. The median time-to-recurrence has not yet been reached; however, in case of a recurrence, the median time-to-recurrence was 2.5 years (minimum: 0.01 years; maximum: 9.8 years). The time-to-recurrence was not statistically significantly associated with gender (HR=0.81; p=0.29), age (HR=1.01; p=0.38) and tumor thickness (HR=1.03; p=0.76). CONCLUSIONS: Long-term surveillance of stage IB melanomas is of utmost importance, because survival subsequent to recurrence is much lower than expected.  The risk of developing a recurrence was substantial; however, the time-to-recurrence was not associated with gender, age and tumor thickness.