Imaging after treatment for melanoma
Melanoma after treatment needs to be followed either by doctor exams, imaging or both. As better treatments appear, there is a growing realization that more and more patients have no evidence of disease for longer periods of time, but some of them will relapse, so how should they be followed?
The role of PET in melanoma is not fully defined. The most recent review by Petrella and others concluded: “PET scanning facilitates the appropriate management of high-risk melanoma patients being considered for operative intervention. PET imaging in addition to CT scanning should be strongly considered before operation in patients at high risk for occult metastatic disease.” It also says that a recommendation cannot be made for or against the use of PET for routine surveillance due to insufficient evidence.
2012 NCCN recommends reimaging of stage I and IIA with CT or PET/CT only for specific signs or symptoms. For stage IIB-IV disese it recommends: “consider chest-X-ray, CT or PET/CT every 6-12 months to screen for recurrent or metastatic disease, for up to 5 years.” Francken et al (2008)proposed a follow-up schedule in stage I annually, stage IIA 6-monthly for 2 years and then annually, stage IIB-IIC 4-monthly for 2 years, 6-monthly in the third year and annually thereafter.
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