Melanoma patients receive more follow‐up care than current guideline recommendations: a study of 546 patients from the general Dutch population

Abstract

Follow-up frequency was higher than recommended by the current melanoma guideline in a large group of patients, mainly those with lower Breslow thickness.

Risk of subsequent cutaneous malignancy in patients with prior melanoma: a systematic review and meta‐analysis

“…melanoma, BCC and SCC) because of their extremely high risk for subsequent malignancies . Other important reasons of following patients with cutaneous malignancies are for psychosocial support, (early) detection of a local recurrence and progression of SCC and melanoma to the draining lymph nodes and visceral organs . Frequency and duration of follow‐up of skin cancer patients remains controversial, but purely from the perspective of developing subsequent cutaneous malignancies lifelong follow‐up seems desirable.…”

Risks of different skin tumour combinations after a first melanoma, squamous cell carcinoma and basal cell carcinoma in Dutch population‐based cohorts: 1989–2009

“…25 The current Dutch Basal cell carcinoma guideline (version 1 May 2014 26 ) advises to educate patients about future risk of subsequent skin cancers, lifelong examinations Table 4 Standardized incidence ratio (SIR and 95% confidence intervals) and absolute excess risk (AER, per 10 000 person-years) of subsequent primary basal cell carcinomas and melanomas after, respectively, melanomas (n = 2422 males + 3354 females) and basal cell carcinomas (n = 20 118 males + 21 367 females) in different follow-up periods and age categories. It is also important to focus on patients' compliance of follow-up guidelines 28 because it may point to early detection on the one hand and the less favourable overdiagnosis on the other hand. High-risk patients (basal cell nevus syndrome, immunosuppressive medication use and patients with extensive actinic damage) are advised to have annual full-skin examinations (or more frequent if needed).…”

The four Ws of skin cancer surveillance in patients with melanoma: Why? Who? When? Where?

“…5 A possible danger of this 'hard' medical perspective is that colleagues will downplay the individual burden of skin cancer as is illustrated in the Dutch melanoma guideline recommending no surveillance for patients with thin melanomas. 6 This is also illustrated by a recent perspective with a suggestion to rephrase basal and squamous cell carcinomas as 'indolent lesions of epithelial origin'. 7 In contrast to the hard arguments there are also 'soft' arguments to follow patients with skin cancer over time.…”

“…Patients with skin cancer are often in need of reassurance, which in practice has shown to result in more doctors' visits than recommended by the national melanoma guideline. 6 Subsequently, these additional follow-up visits are often appreciated by the patients. Although many skin cancers do not progress, the concept of 'field cancerization' should be taken into consideration.…”

“…1 In the same source population, a previous study demonstrated that patients with thin melanomas had many more surveillance visits than recommended by the national guideline. 6 In keratinocytic cancer, the level of evidence is even lower. Improved evidencebased recommendations including a cost-effectiveness analysis concerning surveillance for patients with skin cancer is needed.…”