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A rational approach to melanoma follow‐up in patients with primary cutaneous melanoma
Author(s) -
Tony Dicker,
G.M. Kavanagh,
R. M. Herd,
Tanya Ahmad,
K M McLaren,
U. Chetty,
John Hunter
Publication year - 1999
Publication title -
british journal of dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.304
H-Index - 179
eISSN - 1365-2133
pISSN - 0007-0963
DOI - 10.1046/j.1365-2133.1999.02657.x
Subject(s) - melanoma , primary (astronomy) , dermatology , medicine , cancer research , physics , astronomy
From the Scottish Melanoma Group database for south‐east Scotland we evaluated 5‐year follow‐up in patients with cutaneous malignant melanoma excised between 1979 and 1994 and devised an ‘evidence‐based’ review protocol. Of the 1568 with stage I melanoma, 293 (19%) developed a recurrence, 32 had a second primary melanoma and 97 had an in‐situ melanoma . The disease‐free interval shortened progressively with increasing tumour thickness. Overall, 80% of recurrences were within the first 3 years, but a few patients (< 8%) had recurrences 5 or 10 years after the initial surgery. In‐situ melanomas did not recur. Almost half (47%) the recurrences were noted first by the patient, and only 26% were detected first at a follow‐up clinic. One hundred and thirty‐nine patients (89%) were still under review when their recurrences were detected, and 102 (65%) had been seen within the previous 3 months. Questionnaires were completed by 120 patients: sun protection and avoidance, and mole examination were more likely after melanoma excision. We recommend 3‐monthly review of patients with invasive lesions for the first 3 years. Thereafter, those with lesions ≥ 1.0 mm need two further annual reviews. Patients with in‐situ lesions should be reviewed once, to confirm adequate excision (0.5 cm margins) and to give appropriate education. Surveillance beyond 5 years is only justified if there are special risk factors.