Abstract
Background
The value of follow-up surveillance for patients with cutaneous melanoma remains uncertain. In this prospective study the frequency of detection of first melanoma recurrence (FMR) by patient or doctor was analyzed to assist in the future design of evidence-based follow-up guidelines.
Methods
Patients who had a recurrence of a previously treated American Joint Committee on Cancer (AJCC) stage I–III primary melanoma (PM) were interviewed to ascertain how their PM and FMR were detected. Factors predicting the detection of PM and FMR were analyzed.
Results
The study group comprised 211 patients. In 168 patients, information on detection of their PM was available; 102 PMs (61%) were detected by the patient and 18 (11%) by their partner. Higher AJCC stage, visible location for the patient, and female sex were independent predictive factors for patient-detected PM (P = .03, .002, and .02 respectively). The FMR type was local in 28 (13%), in transit in 35 (17%), in regional lymph nodes in 97 (46%), and distant in 51 (24%). Seventy-three percent of all FMRs were detected by the patient. The presence of a symptom was the only independent predictor of a patient-detected FMR (P < .0001). There was no statistically significant survival difference between the patient-detected and doctor-detected FMRs.
Conclusions
Three-quarters of FMRs were detected by patients or their partners, and it should be possible to improve this rate even further by better education. More frequent follow-up visits are thus unlikely to be valuable. Reductions in follow-up frequency may therefore be safe and economically responsible.
Similar content being viewed by others
References
Francken AB, Bastiaannet E, Hoekstra HJ. Follow-up in patients with localised primary cutaneous melanoma. Lancet Oncol 2005; 6:608–21
Hofmann U, Szedlak M, Rittgen W, et al. Primary staging and follow-up in melanoma patients—monocenter evaluation of methods, costs and patient survival. Br J Cancer 2002; 87:151–7
Moloney DM, Gordon DJ, Briggs JC, et al. Recurrence of thin melanoma: how effective is follow-up? Br J Plast Surg 1996; 49:409–13
Mooney MM, Kulas M, McKinley B, et al. Impact on survival by method of recurrence detection in stage I and II cutaneous melanoma. Ann Surg Oncol 1998; 5:54–63
Shumate CR, Urist MM, Maddox WA. Melanoma recurrence surveillance. Patient or physician based? Ann Surg 1995; 221:566–9
Kittler H, Weitzdorfer R, Pehamberger H, et al. Compliance with follow-up and prognosis among patients with thin melanomas. Eur J Cancer 2001; 37:1504–9
Garbe C, Paul A, Kohler-Spath H, et al. Prospective evaluation of a follow-up schedule in cutaneous melanoma patients: recommendations for an effective follow-up strategy. J Clin Oncol 2003; 21:520–9
Sylaidis P, Gordon D, Rigby H, et al. Follow-up requirements for thick cutaneous melanoma. Br J Plast Surg 1997; 50:349–53
McCarthy WH, Shaw HM, Thompson JF, et al. Time and frequency of recurrence of cutaneous stage I malignant melanoma with guidelines for follow-up study. Surg Gynecol Obstet 1988; 166:497–502
Baughan CA, Hall VL, Leppard BJ, et al. Follow-up in stage I cutaneous malignant melanoma: an audit. Clin Oncol (R Coll Radiol) 1993; 5:174–80
Basseres N, Grob JJ, Richard MA, et al. Cost-effectiveness of surveillance of stage I melanoma. A retrospective appraisal based on a 10-year experience in a dermatology department in France. Dermatology 1995; 191:199–203
Poo-Hwu WJ, Ariyan S, Lamb L, et al. Follow-up recommendations for patients with American Joint Committee on Cancer Stages I–III malignant melanoma. Cancer 1999; 86:2252–8
Regan MW, Reid CD, Griffiths RW, et al. Malignant melanoma, evaluation of clinical follow up by questionnaire survey. Br J Plast Surg 1985; 38:11–4
Ruark DS, Shaw HM, Ingvar C, McCarthy WH, Thompson JF. Who detects the first recurrence in stage I cutaneous melanoma? (abstract). Melanoma Res 1993; 3(Suppl 1):44
Weiss M, Loprinzi CL, Creagan ET, et al. Utility of follow-up tests for detecting recurrent disease in patients with malignant melanomas. JAMA 1995; 274:1703–5
Kim CJ, Reintgen DS, Balch CM. The new melanoma staging system. Cancer Control 2002; 9:9–15
Blum A, Brand CU, Ellwanger U, et al. Awareness and early detection of cutaneous melanoma: an analysis of factors related to delay in treatment. Br J Dermatol 1999; 141:783–7
Brady MS, Oliveria SA, Christos PJ, et al. Patterns of detection in patients with cutaneous melanoma. Cancer 2000; 89:342–7
Epstein DS, Lange JR, Gruber SB, et al. Is physician detection associated with thinner melanomas? JAMA 1999; 281:640–3
Schmid-Wendtner MH, Baumert J, Stange J, et al. Delay in the diagnosis of cutaneous melanoma: an analysis of 233 patients. Melanoma Res 2002; 12:389–94
Lowe JB, Ball J, Lynch BM, et al. Acceptability and feasibility of a community-based screening programme for melanoma in Australia. Health Promot Int 2004; 19:437–44
Richard MA, Grob JJ, Avril MF, et al. Delays in diagnosis and melanoma prognosis (I): the role of patients. Int J Cancer 2000; 89:271–9
Kersey PA, Iscoe NA, Gapski JA, et al. The value of staging and serial follow-up investigations in patients with completely resected, primary, cutaneous malignant melanoma. Br J Surg 1985; 72:614–7
Johnson TM, Hamilton T, Lowe L. Multiple primary melanomas. J Am Acad Dermatol 1998; 39:422–7
Brobeil A, Rapaport D, Wells K, et al. Multiple primary melanomas: implications for screening and follow-up programs for melanoma. Ann Surg Oncol 1997; 4:19–23
Ariyan S, Poo WJ, Bolognia J, et al. Multiple primary melanomas: data and significance. Plast Reconstr Surg 1995; 96:1384–9
Dicker TJ, Kavanagh GM, Herd RM, et al. A rational approach to melanoma follow-up in patients with primary cutaneous melanoma. Scottish Melanoma Group. Br J Dermatol 1999; 140:249–54
Martini L, Brandani P, Chiarugi C, et al. First recurrence analysis of 840 cutaneous melanomas: a proposal for a follow-up schedule. Tumori 1994; 80:188–97
Garbe C, Schadendorf D. Surveillance and follow-up examinations in cutaneous melanoma. Onkologie 2003; 26:241–6
Acknowledgments
Supported in part by Stichting VSB Fonds, Stichting Dr. Hendrik Muller’s Vaderlandsch Fonds, Stichting Fonds Doctor Catherine van Tussenbroek—Nell Ongerboer Fonds, Stichting Groninger Universiteits Fonds, Stichting De Korintiers, KWF Kankerbestrijding, Marco Polo Fonds, and the Melanoma Foundation of the University of Sydney.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Francken, A.B., Shaw, H.M., Accortt, N.A. et al. Detection of First Relapse in Cutaneous Melanoma Patients: Implications for the Formulation of Evidence-Based Follow-up Guidelines. Ann Surg Oncol 14, 1924–1933 (2007). https://doi.org/10.1245/s10434-007-9347-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1245/s10434-007-9347-2