A rational approach to melanoma follow-up in patients with primary cutaneous melanoma

Abstract

From the Scottish Melanoma Group database for south-east Scotland we evaluated 5-year follow-up in patients with cutaneous malignant melanoma excised between 1979 and 1994 and devised an 'evidence-based' review protocol. Of the 1568 with stage I melanoma, 293 (19%) developed a recurrence, 32 had a second primary melanoma and 97 had an in-situ melanoma. The disease-free interval shortened progressively with increasing tumour thickness. Overall, 80% of recurrences were within the first 3 years, but a few patients (< 8%) had recurrences 5 or 10 years after the initial surgery. In-situ melanomas did not recur. Almost half (47%) the recurrences were noted first by the patient, and only 26% were detected first at a follow-up clinic. One hundred and thirty-nine patients (89%) were still under review when their recurrences were detected, and 102 (65%) had been seen within the previous 3 months. Questionnaires were completed by 120 patients: sun protection and avoidance, and mole examination were more likely after melanoma excision. We recommend 3-monthly review of patients with invasive lesions for the first 3 years. Thereafter, those with lesions >/= 1.0 mm need two further annual reviews. Patients with in-situ lesions should be reviewed once, to confirm adequate excision (0.5 cm margins) and to give appropriate education. Surveillance beyond 5 years is only justified if there are special risk factors.

Primary staging and follow-up in melanoma patients – monocenter evaluation of methods, costs and patient survival

“…In patients attending the FU I/II program, about 68% of first relapses were detected due to scheduled follow-up activity. This is a significantly higher yield than reported by Dicker et al (1999) who found only 26% of first recurrences detected at the follow-up clinic. Baughan et al (1993), Kersey et al (1985) as well as Bassères et al (1995) found 41, 44 and 50%, respectively, of all first relapses to be detected by routine follow-up activity considering only the purely doctor-diagnosed recurrences.…”

Malignant Melanoma S3‐Guideline “Diagnosis, Therapy and Follow‐up of Melanoma”

“…[588][589][590][600][601][602][603]. Median occurrence of regional lymph node metastases was earlier than in locoregional or distant metastases (recurrence-free survival 17.6 months vs. 23, respectively 25.9 months) [604].…”

“…Depending on tumor thickness, the majority of recurrences even in thin melanomas (< 1.0 mm), occurred within the first years after primary diagnosis [590,596,599]. The risk for recurrence after 10 years is roughly 1 % [588].…”

“…Since the 1990s various proposals regarding follow-up for melanoma patients have been recommended, yet there is no international consensus [588,590,592]. Some authors recommend a 10-year, risk-adapted follow-up with increasing intervals between exams over the course of time.…”

The influence of pregnancy, parity, and sex on melanoma prognosis

“…In comparison melanomas of >1.5mm have a greater risk of recurrence in the first year following a diagnosis. This then decreases to below 2% after the first 5 years (83)(84)(85). Across all melanoma stages approximately 80% of recurrences will occur in the first 3 years (83,86,87).…”