Follow-up in patients with localised primary cutaneous melanoma

• Published in: The lancet oncology 2005-08, Vol.6 (8), p.608-621
• Main Authors: Francken, Anne Brecht, Bastiaannet, Esther, Hoekstra, Harald J
• Format: Article
• Language: English
• Subjects: Costs and Cost Analysis; Evidence-Based Medicine; Health Care Costs - statistics & numerical data; Humans; Melanoma; Melanoma - economics; Melanoma - pathology; Metastasis; Neoplasm Metastasis - diagnosis; Neoplasm Recurrence, Local - diagnosis; Patient Satisfaction; Patients; Physical Examination - economics; Practice Guidelines as Topic; Practice Patterns, Physicians; Prognosis; Quality of Life; Skin Neoplasms - economics; Skin Neoplasms - pathology; Surveillance; Survival Analysis; Treatment Outcome
• ISSN: 1470-2045; 1474-5488
• DOI: 10.1016/S1470-2045(05)70283-7

Follow-up services for patients with localised cutaneous melanoma are widely discussed but there is no international consensus. Our aim was to discuss frequency and duration of follow-up, type of health professional involved, optimum intensity of routine investigation, and patients' satisfaction with follow-up. Searches of the published work were directed at publications between January, 1985, and February, 2004 on recurrences, subsequent primary melanoma, routine tests, and patients' satisfaction. In a selection of 72 articles, 2142 (6·6%) recurrences were reported, 62% of which were detected by the patients themselves. 2.6% of patients developed a subsequent primary melanoma. Most investigators do not support high-intensity routine follow-up investigations. Of the various follow-up investigations requested by physicians, only medical history and physical examination seem to be cost effective. Lymph-node sonography seems to be a promising method for detection, although survival benefit remains to be proven. Patients were found to be anxious about follow-up visits, although other research showed that provision of information to patients was much appreciated. Published work on the follow-up of patients with cutaneous melanoma has mainly been retrospective and descriptive. Recommendations can be given with only a low grade of evidence. For meaningful guidelines to be developed, prospective, high-quality methodological research is needed.