Performance of diagnostic tests in an intensive follow-up protocol for patients with American Joint Committee on Cancer (AJCC) stage IIB, IIC, and III localized primary melanoma: A prospective cohort study

Background There is no international consensus on optimal follow-up schedules and which supplementary tests should be used after resection of a primary melanoma. Objective We sought to analyze the performance of the follow-up components and identify procedures that detect melanoma metastasis earlier...

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Bibliographic Details
Published in:Journal of the American Academy of Dermatology 2016-09, Vol.75 (3), p.516-524
Main Authors: Podlipnik, Sebastian, MD, Carrera, Cristina, MD, PhD, Sánchez, Marcelo, MD, Arguis, Pedro, MD, Olondo, Maria L., MD, Vilana, Ramon, MD, Rull, Ramon, MD, Vidal-Sicart, Sergi, MD, PhD, Vilalta, Antonio, MD, Conill, Carles, MD, Malvehy, Josep, MD, PhD, Puig, Susana, MD, PhD
Format: Article
Language:English
Subjects:
Adult
Aged
Cohort Studies
computed tomography scan
Dermatology
Diagnostic Tests, Routine - methods
Disease-Free Survival
Female
follow-up
Follow-Up Studies
Hematologic Tests
Humans
Lymph Nodes - pathology
magnetic resonance imaging
Male
melanoma
Melanoma - diagnosis
Melanoma - mortality
Melanoma - therapy
Melanoma, Cutaneous Malignant
melanoma-inhibitory activity
Middle Aged
Monitoring, Physiologic - methods
Multimodal Imaging - methods
Outcome Assessment, Health Care
Physical Examination - methods
Prospective Studies
recurrences
Risk Assessment
S100B
Self-Examination
Skin Neoplasms - diagnosis
Skin Neoplasms - mortality
Skin Neoplasms - therapy
Societies, Medical
Survival Analysis
ultrasonography
United States
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Summary:Background There is no international consensus on optimal follow-up schedules and which supplementary tests should be used after resection of a primary melanoma. Objective We sought to analyze the performance of the follow-up components and identify procedures that detect melanoma metastasis earlier. Methods This was a prospective cohort from 290 consecutive patients given a diagnosis of stage IIB, IIC, and III melanoma. Patients were followed up with an intensive protocol based on imaging studies (computed tomography of the chest, abdomen, and pelvis, and brain magnetic resonance imaging), periodic laboratory tests, regular physical examinations, and patient self-examinations. Results A total of 2382 clinical examinations and 3069 imaging tests were performed. The patients completed 899.8 person-years of follow-up, with a median of 2.5 years. In all, 115 recurrences in 290 patients were recorded, of which computed tomography detected 48.3%; brain magnetic resonance imaging, 7.6%; laboratory test, 2.5%; physician, 23.7%; and patient, 17.8%. Limitations Patients with stage III melanoma were not systematically classified into subgroups and overall survival was not evaluated. Conclusion We observed that this intensive monitoring is appropriate for early detection of recurrence in stage IIB, IIC, and III melanoma. Prompt diagnosis of metastasis and the recent development of new therapeutic targets may improve overall survival.
ISSN:0190-9622
1097-6787
DOI:10.1016/j.jaad.2016.02.1229