Routine surveillance after surgery for melanoma – pro
Guidelines do not recommend routine suveillance afer a complete resection for stage I-II, although NCCN says that “consider chest x-ray, CT or PET to screen for recurrent metastatic disease.” For stage III-IV, NCCN recommends chest xray, CT or PEt every 6-12 months. This is a level 2b recommendation.
There are two reccent studies that undermine the concept of routine surveillance for melanoma.One prospectively used a monitoring schedule of 6-monthly chest X-rays (CXR) in addition to clinical follow-up. They found metastases in 21% (n = 23) of the patients, which were detected in 48% (n = 11) by surveillance CXR. The other pulmonary metastases were not detected by CXR surveillance. The authors found sensitivity and specificity for surveillance CXR was 48% [95% confidence interval (CI) 0.27–0.68] and 78% (95%CI 0.77–0.79), respectively. In only 13% (n = 3) was metastasectomy considered appropriate. Moreover, 19 patients had a false-positive result for melanoma metastasis, 10 of whom underwent a pulmonary biopsy. This study confirms earlier results of retrospective studies: routine CXR does not seem to contribute to an improvement in survival of melanoma patients, nor is it cost effective. Another study was a retrospective report of 118 American Joint Committee on Cancer (AJCC) stage II and III melanoma patients who underwent regular structural imaging with a minimum follow-up of 2 years. Recurrence occurred in 35% (n = 43), of which 43% (n = 15) were distant metastases. However, only 7% (n = 3) of these patients were asymptomatic and had their recurrence detected by routine imaging. Another 26% (n = 11) were detected by routine clinical follow-up, including medical history and physical examination. This study is consistent with previous reports that found two-thirds of melanoma recurrences were patient detected.
nccn.org, melanoma, p.ME-6
F. Anne Brecht Francken and Harald J. Hoekstra Flow-Up of Melanoma Patients: The Need for Evidence-Based Protocols Journal Annals of Surgical Oncology Volume 16, Number 4 / April, 2009 804-805