Annals of Surgical Oncology

, Volume 14, Issue 6, pp 1924–1933 | Cite as

Detection of First Relapse in Cutaneous Melanoma Patients: Implications for the Formulation of Evidence-Based Follow-up Guidelines

  • Anne Brecht Francken
  • Helen M. Shaw
  • Neil A. Accortt
  • Seng-Jaw Soong
  • Harald J. Hoekstra
  • John F. Thompson
Melanomas

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.

Keywords

Melanoma Recurrence Follow-up Self-examination 

Notes

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.

References

  1. 1.
    Francken AB, Bastiaannet E, Hoekstra HJ. Follow-up in patients with localised primary cutaneous melanoma. Lancet Oncol 2005; 6:608–21PubMedCrossRefGoogle Scholar
  2. 2.
    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; 87:151–7PubMedCrossRefGoogle Scholar
  3. 3.
    Moloney DM, Gordon DJ, Briggs JC, et al. Recurrence of thin melanoma: how effective is follow-up? Br J Plast Surg 1996; 49:409–13PubMedCrossRefGoogle Scholar
  4. 4.
    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; 5:54–63PubMedCrossRefGoogle Scholar
  5. 5.
    Shumate CR, Urist MM, Maddox WA. Melanoma recurrence surveillance. Patient or physician based? Ann Surg 1995; 221:566–9PubMedCrossRefGoogle Scholar
  6. 6.
    Kittler H, Weitzdorfer R, Pehamberger H, et al. Compliance with follow-up and prognosis among patients with thin melanomas. Eur J Cancer 2001; 37:1504–9PubMedCrossRefGoogle Scholar
  7. 7.
    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; 21:520–9PubMedCrossRefGoogle Scholar
  8. 8.
    Sylaidis P, Gordon D, Rigby H, et al. Follow-up requirements for thick cutaneous melanoma. Br J Plast Surg 1997; 50:349–53PubMedCrossRefGoogle Scholar
  9. 9.
    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; 166:497–502PubMedGoogle Scholar
  10. 10.
    Baughan CA, Hall VL, Leppard BJ, et al. Follow-up in stage I cutaneous malignant melanoma: an audit. Clin Oncol (R Coll Radiol) 1993; 5:174–80Google Scholar
  11. 11.
    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; 191:199–203PubMedCrossRefGoogle Scholar
  12. 12.
    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; 86:2252–8PubMedCrossRefGoogle Scholar
  13. 13.
    Regan MW, Reid CD, Griffiths RW, et al. Malignant melanoma, evaluation of clinical follow up by questionnaire survey. Br J Plast Surg 1985; 38:11–4PubMedCrossRefGoogle Scholar
  14. 14.
    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):44CrossRefGoogle Scholar
  15. 15.
    Weiss M, Loprinzi CL, Creagan ET, et al. Utility of follow-up tests for detecting recurrent disease in patients with malignant melanomas. JAMA 1995; 274:1703–5PubMedCrossRefGoogle Scholar
  16. 16.
    Kim CJ, Reintgen DS, Balch CM. The new melanoma staging system. Cancer Control 2002; 9:9–15PubMedGoogle Scholar
  17. 17.
    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; 141:783–7PubMedCrossRefGoogle Scholar
  18. 18.
    Brady MS, Oliveria SA, Christos PJ, et al. Patterns of detection in patients with cutaneous melanoma. Cancer 2000; 89:342–7PubMedCrossRefGoogle Scholar
  19. 19.
    Epstein DS, Lange JR, Gruber SB, et al. Is physician detection associated with thinner melanomas? JAMA 1999; 281:640–3PubMedCrossRefGoogle Scholar
  20. 20.
    Schmid-Wendtner MH, Baumert J, Stange J, et al. Delay in the diagnosis of cutaneous melanoma: an analysis of 233 patients. Melanoma Res 2002; 12:389–94PubMedCrossRefGoogle Scholar
  21. 21.
    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; 19:437–44PubMedCrossRefGoogle Scholar
  22. 22.
    Richard MA, Grob JJ, Avril MF, et al. Delays in diagnosis and melanoma prognosis (I): the role of patients. Int J Cancer 2000; 89:271–9PubMedCrossRefGoogle Scholar
  23. 23.
    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; 72:614–7PubMedCrossRefGoogle Scholar
  24. 24.
    Johnson TM, Hamilton T, Lowe L. Multiple primary melanomas. J Am Acad Dermatol 1998; 39:422–7PubMedCrossRefGoogle Scholar
  25. 25.
    Brobeil A, Rapaport D, Wells K, et al. Multiple primary melanomas: implications for screening and follow-up programs for melanoma. Ann Surg Oncol 1997; 4:19–23PubMedCrossRefGoogle Scholar
  26. 26.
    Ariyan S, Poo WJ, Bolognia J, et al. Multiple primary melanomas: data and significance. Plast Reconstr Surg 1995; 96:1384–9PubMedCrossRefGoogle Scholar
  27. 27.
    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; 140:249–54PubMedCrossRefGoogle Scholar
  28. 28.
    Martini L, Brandani P, Chiarugi C, et al. First recurrence analysis of 840 cutaneous melanomas: a proposal for a follow-up schedule. Tumori 1994; 80:188–97PubMedGoogle Scholar
  29. 29.
    Garbe C, Schadendorf D. Surveillance and follow-up examinations in cutaneous melanoma. Onkologie 2003; 26:241–6PubMedCrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2007

Authors and Affiliations

  • Anne Brecht Francken
    • 1
    • 3
  • Helen M. Shaw
    • 1
    • 2
  • Neil A. Accortt
    • 4
  • Seng-Jaw Soong
    • 4
  • Harald J. Hoekstra
    • 3
  • John F. Thompson
    • 1
    • 2
  1. 1.Sydney Melanoma Unit, Sydney Cancer CentreRoyal Prince Alfred HospitalNew South WalesAustralia
  2. 2.Discipline of SurgeryUniversity of SydneyNew South WalesAustralia
  3. 3.University Medical Center Groningen and University of GroningenGroningenThe Netherlands
  4. 4.Biostatistics and Bioinformatic Unit, Comprehensive Cancer CenterUniversity of Alabama at Birmingham, 153 Wallace Tumor InstituteBirmingham, AlabamaUnited States of America

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