Recurrences of stage-II melanoma are more reliably detected by patient self-check or physician exam than routine imaging. That finding suggests that clinical follow up and patient education are critical for improving detection of melanoma recurrence, researchers report online in Journal of the American College of Surgeons (Feb. 8, 2017).
The authors note that while melanoma has a high cure rate if caught early, there is evidence that its recurrence rate may be as high as 50%. “We are most concerned about patients who have stage II melanoma,” study coauthor Dr. Adam C. Berger, professor of surgery at Thomas Jefferson University, Philadelphia, in a press release from the American College of Surgeons. “They have more advanced primary melanomas, and on average, between 20 and 45 per cent of these patients will die within five years. In the past, we didn’t have good therapies for this type of melanoma, but new therapies mean survival continues to improve.”
Records on a total of 581 patients with stage II melanoma with at least one year of follow-up between 1996 and 2015 were found in melanoma databases from Thomas Jefferson University and the University of North Carolina in Chapel Hill, N.C. There were 171 patients with early-stage melanoma (29.4 per cent) who developed a recurrence, with male sex, ulceration, and stage being significant predictors.
“We wanted to get a breakdown on how we are discovering recurring melanomas,” Dr. Berger said. The authors wanted to know whether the recurrence was detected by a change in the lesion that a patient observed which led them to see a doctor, a symptom a physician identified during a scheduled visit, or a factor detected with routine imaging.
They found that the most frequent mode of detection was patient-reported symptoms (40%), followed by physician exam (30%) and surveillance imaging (26%), and this did not differ significantly by stage.
Recurrence most commonly occurred at regional nodes (30%), followed by the lungs (27%), and in-transit (18%).
“The fact that imaging picked up 26 per cent of patients with recurrence is notable because it is a little higher than what we’ve seen in the past, which I think reflects the current trend to do more imaging in general,” Dr. Berger said. “There is a move to use CT scans and other imaging techniques as an important strategy in early recurrence detection.”
Dr. Berger and his colleagues expect their findings will help reshape protocols for people diagnosed with melanoma. “Our hope is to have some impact on future follow-up guidelines and how we think about screening for recurrent melanoma. Every study like this helps contribute to framing those guidelines,” he said. Particularly, individuals previously diagnosed with early stage melanoma need to be on the alert for symptoms of recurrence.
“Patients need to be aware of all of their symptoms and their body. But it’s also important for physicians to educate patients as to what to look for and what symptoms are a cause for concern,” Dr. Berger said. “Patients should examine their skin and the area where lymph nodes would be on a monthly basis.” If the patient finds a symptom, and it does not resolve on its own after two to three weeks, it should be brought to a physician’s attention, because that is an indicator that the melanoma has returned, he said.