Patient Symptoms Are the Most Frequent Indicators of Recurrence in Patients with American Joint Committee on Cancer Stage II Melanoma

Berger, Adam C.; Ollila, David W.; Christopher, Adrienne N.; Kairys, John C.; Mastrangelo, Michael J.; Feeney, Kendra J.; Dabbish, Nooreen; Leiby, Benjamin E.; Frank, Jill; Stitzenberg, Karyn B.; Meyers, Michael O.

doi:10.1016/j.jamcollsurg.2016.12.038

Cited by 31 publications

(34 citation statements)

References 17 publications

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“…This study describes one the largest cohorts of patients with Stage II cutaneous melanoma published to date, and it is the first to report dynamic changes in the risks of recurrence over time. Recurrent melanoma was detected in 27.2% of patients in this cohort, which is comparable to recurrence rates of 29.6% (219/738) and 29.4% (171/581) in other large published cohorts of Stage II melanoma patients 5,6 . While we report a larger proportion of patients with head and neck primary tumors compared to other published cohort, the patient population and primary tumors were otherwise similar.…”

Section: Discussionsupporting

confidence: 79%

“…Understanding these recurrence patterns is necessary for the development of optimal surveillance strategies. The current NCCN guidelines on surveillance of Stage II melanoma were developed in part from recent studies reporting that most recurrences are local or regional and that patient symptoms, not imaging, are the most frequent method of recurrence detection 5,6 . Additionally, reduced follow‐up schedules have been shown to be safe and cost‐effective for Stage I and II melanoma 7‐9 .…”

Section: Introductionmentioning

confidence: 99%

“…The current NCCN guidelines on surveillance of Stage II melanoma were developed in part from recent studies reporting that most recurrences are local or regional and that patient symptoms, not imaging, are the most frequent method of recurrence detection. 5,6 Additionally, reduced follow-up schedules have been shown to be safe and cost-effective for Stage I and II melanoma. [7][8][9] However, most of these studies were performed in the era before effective systemic therapy for relapse.…”

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confidence: 99%

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Recurrence patterns in patients with Stage II melanoma: The evolving role of routine imaging for surveillance

Bleicher

Swords

Mali

et al. 2020

Journal of Surgical Oncology

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Background and Objectives: The relatively recent availability of effective systemic therapies for metastatic melanoma necessitates reconsideration of current surveillance patterns. Evidence supporting surveillance guidelines for resected Stage II melanoma is lacking. Prior reports note routine imaging detects only 21% of recurrent disease. This study aims to define recurrence patterns for Stage II melanoma to inform future surveillance guidelines. Methods: This is a retrospective study of patients with Stage II melanoma. We analyzed risk factors for recurrence and methods of recurrence detection. We also assessed survival. Yearly hazards of recurrence were visualized. Results: With a median follow-up of 4.9 years, 158 per 580 patients (27.2%) recurred. Overall, most recurrences were patient-detected (60.7%) or imagingdetected (27.3%). Routine imaging was important in detecting recurrence in patients with distant recurrences (adjusted rate 43.1% vs. 9.4% for local/in-transit; p = .04) and with Stage IIC melanoma (42.5% vs. 18.5% for IIA; p = .01). Male patients also self-detected recurrent disease less than females (52.1% vs. 76.8%; p < .01). Conclusions: Routine imaging surveillance played a larger role in detecting recurrent disease for select groups in this cohort than noted in prior studies. In an era of effective systemic therapy, routine imaging should be considered for detection of asymptomatic relapse for select, high-risk patient groups.

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Section: Discussionsupporting

confidence: 79%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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Recurrence patterns in patients with Stage II melanoma: The evolving role of routine imaging for surveillance

Bleicher

Swords

Mali

et al. 2020

Journal of Surgical Oncology

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“…They recommend to perform additional testing and imaging only when (distant) recurrent disease is suspected. 7,13,14,32 For patients with local, regional, or metastatic disease, various treatment options are available, namely systemic treatment options such as BRAF/MEK inhibitors, and immunologic strategies with CTLA4, PD-1/PD-L1 antagonists that result in significantly improved survival rates 33 After 3 years, a less-frequent follow-up schedule resulted in a considerable cost reduction (39%), as found after 1 year. 16 Healthcare costs are high, financially burdening healthcare systems and societies.…”

Section: Discussionmentioning

confidence: 99%

The MELFO Study: A Multicenter, Prospective, Randomized Clinical Trial on the Effects of a Reduced Stage-Adjusted Follow-Up Schedule on Cutaneous Melanoma IB–IIC Patients—Results After 3 Years

et al. 2019

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Background This study compares well-being, recurrences, and deaths of early-stage cutaneous melanoma patients in follow-up, as recommended in the Dutch guideline, with that of patients in a stage-adjusted reduced follow-up schedule, 3 years after diagnosis, as well as costs. Methods Overall, 180 eligible pathological American Joint Committee on Cancer (AJCC) stage IB–IIC, sentinel node staged, melanoma patients (response rate = 87%, 48% male, median age 57 years), randomized into a conventional (CSG, n = 93) or experimental (ESG, n = 87) follow-up schedule group, completed patient-reported outcome measures (PROMs) at diagnosis (T1): State-Trait Anxiety Inventory–State version (STAI-S), Cancer Worry Scale (CWS), Impact of Event Scale (IES), and RAND-36 (Mental and Physical Component scales [PCS/MCS]). Three years later (T3), 110 patients (CSG, n = 56; ESG, n = 54) completed PROMs, while 42 declined (23%). Results Repeated measures analyses of variance (ANOVAs) showed a significant group effect on the IES (p = 0.001) in favor of the ESG, and on the RAND-36 PCS (p = 0.02) favoring the CSG. Mean IES and CWS scores decreased significantly over time, while those on the RAND-36 MCS and PCS increased. Effect sizes were small. Twenty-five patients developed a recurrence or second primary melanoma, of whom 13 patients died within 3 years. Cox proportional hazards models showed no differences between groups in recurrence-free survival (hazard ratio [HR] 0.71 [0.32–1.58]; p = 0.400) and disease-free survival (HR 1.24 [0.42–3.71]; p = 0.690). Costs per patient after 3 years (computed for 77.3% of patients) were 39% lower in the ESG. Conclusion These results seemingly support the notion that a stage-adjusted reduced follow-up schedule forms an appropriate, safe, and cost-effective alternative for pathological AJCC stage IB–IIC melanoma patients to the follow-up regimen as advised in the current melanoma guideline.

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“…Different studies have shown that 40–60% of relapses are detected by the patient or his relatives or in a complete physical examination (around 30%) (Berger et al, 2017; Meyers et al, 2009; Moore Dalal et al, 2008). Similar percentages were found in our study.…”

Section: Discussionmentioning

confidence: 99%

Study of cutaneous melanoma recurrences after sentinel node biopsy: Patterns of dissemination and use of complementary test in follow‐up

et al. 2020

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Objectives To investigate the patterns of melanoma recurrence in the local population, including factors that may influence in this event and timing of relapse, and to determine the mode of detection of them. Methods This is a retrospective cohort study of patients with melanoma who underwent sentinel lymph node biopsy at the Complejo Hospitalario de Navarra (Spain) from 2002 to 2012. The following data were collected of each patient: age, gender, date of diagnosis, location of melanoma, histological subtype, Breslow thickness, ulceration, mitosis, sentinel node status, AJCC 8th edition stage, site of first diagnosed metastasis, mode of relapse, date of first relapse and time of death. Results Of 308 patients, 30% people suffered metastasis. The mean follow‐up time was 68.63 months. 51.1% of relapses were locoregional and 48.9% haemato‐visceral. Sentinel node status was the only variable associated with higher risk of haemato‐visceral metastasis (p < 0.001). The mean time between diagnosis of melanoma and recurrence was 2.7 years. Most recurrences were detected by the patient himself or had any type of symptoms and were consequently selected for a complementary test. Conclusion It is important to follow‐up all patients with diagnosis of cutaneous melanoma, essentially during the first 5 years after diagnosis.

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Patient Symptoms Are the Most Frequent Indicators of Recurrence in Patients with American Joint Committee on Cancer Stage II Melanoma

Cited by 31 publications

References 17 publications

Recurrence patterns in patients with Stage II melanoma: The evolving role of routine imaging for surveillance

Recurrence patterns in patients with Stage II melanoma: The evolving role of routine imaging for surveillance

The MELFO Study: A Multicenter, Prospective, Randomized Clinical Trial on the Effects of a Reduced Stage-Adjusted Follow-Up Schedule on Cutaneous Melanoma IB–IIC Patients—Results After 3 Years

Study of cutaneous melanoma recurrences after sentinel node biopsy: Patterns of dissemination and use of complementary test in follow‐up

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