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Erschienen in: Annals of Surgical Oncology 6/2007

01.06.2007 | Melanomas

Detection of First Relapse in Cutaneous Melanoma Patients: Implications for the Formulation of Evidence-Based Follow-up Guidelines

verfasst von: Anne Brecht Francken, MD, Helen M. Shaw, PhD, Neil A. Accortt, PhD, Seng-Jaw Soong, PhD, Harald J. Hoekstra, MD, John F. Thompson, MD

Erschienen in: Annals of Surgical Oncology | Ausgabe 6/2007

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Abstract

Background

The value of follow-up surveillance for patients with cutaneous melanoma remains uncertain. In this prospective study the frequency of detection of first melanoma recurrence (FMR) by patient or doctor was analyzed to assist in the future design of evidence-based follow-up guidelines.

Methods

Patients who had a recurrence of a previously treated American Joint Committee on Cancer (AJCC) stage I–III primary melanoma (PM) were interviewed to ascertain how their PM and FMR were detected. Factors predicting the detection of PM and FMR were analyzed.

Results

The study group comprised 211 patients. In 168 patients, information on detection of their PM was available; 102 PMs (61%) were detected by the patient and 18 (11%) by their partner. Higher AJCC stage, visible location for the patient, and female sex were independent predictive factors for patient-detected PM (P = .03, .002, and .02 respectively). The FMR type was local in 28 (13%), in transit in 35 (17%), in regional lymph nodes in 97 (46%), and distant in 51 (24%). Seventy-three percent of all FMRs were detected by the patient. The presence of a symptom was the only independent predictor of a patient-detected FMR (P < .0001). There was no statistically significant survival difference between the patient-detected and doctor-detected FMRs.

Conclusions

Three-quarters of FMRs were detected by patients or their partners, and it should be possible to improve this rate even further by better education. More frequent follow-up visits are thus unlikely to be valuable. Reductions in follow-up frequency may therefore be safe and economically responsible.
Literatur
1.
Zurück zum Zitat Francken AB, Bastiaannet E, Hoekstra HJ. Follow-up in patients with localised primary cutaneous melanoma. Lancet Oncol 2005; 6:608–21PubMedCrossRef Francken AB, Bastiaannet E, Hoekstra HJ. Follow-up in patients with localised primary cutaneous melanoma. Lancet Oncol 2005; 6:608–21PubMedCrossRef
2.
Zurück zum Zitat Hofmann U, Szedlak M, Rittgen W, et al. Primary staging and follow-up in melanoma patients—monocenter evaluation of methods, costs and patient survival. Br J Cancer 2002; 87:151–7PubMedCrossRef Hofmann U, Szedlak M, Rittgen W, et al. Primary staging and follow-up in melanoma patients—monocenter evaluation of methods, costs and patient survival. Br J Cancer 2002; 87:151–7PubMedCrossRef
3.
Zurück zum Zitat Moloney DM, Gordon DJ, Briggs JC, et al. Recurrence of thin melanoma: how effective is follow-up? Br J Plast Surg 1996; 49:409–13PubMedCrossRef Moloney DM, Gordon DJ, Briggs JC, et al. Recurrence of thin melanoma: how effective is follow-up? Br J Plast Surg 1996; 49:409–13PubMedCrossRef
4.
Zurück zum Zitat Mooney MM, Kulas M, McKinley B, et al. Impact on survival by method of recurrence detection in stage I and II cutaneous melanoma. Ann Surg Oncol 1998; 5:54–63PubMedCrossRef Mooney MM, Kulas M, McKinley B, et al. Impact on survival by method of recurrence detection in stage I and II cutaneous melanoma. Ann Surg Oncol 1998; 5:54–63PubMedCrossRef
5.
Zurück zum Zitat Shumate CR, Urist MM, Maddox WA. Melanoma recurrence surveillance. Patient or physician based? Ann Surg 1995; 221:566–9PubMedCrossRef Shumate CR, Urist MM, Maddox WA. Melanoma recurrence surveillance. Patient or physician based? Ann Surg 1995; 221:566–9PubMedCrossRef
6.
Zurück zum Zitat Kittler H, Weitzdorfer R, Pehamberger H, et al. Compliance with follow-up and prognosis among patients with thin melanomas. Eur J Cancer 2001; 37:1504–9PubMedCrossRef Kittler H, Weitzdorfer R, Pehamberger H, et al. Compliance with follow-up and prognosis among patients with thin melanomas. Eur J Cancer 2001; 37:1504–9PubMedCrossRef
7.
Zurück zum Zitat Garbe C, Paul A, Kohler-Spath H, et al. Prospective evaluation of a follow-up schedule in cutaneous melanoma patients: recommendations for an effective follow-up strategy. J Clin Oncol 2003; 21:520–9PubMedCrossRef Garbe C, Paul A, Kohler-Spath H, et al. Prospective evaluation of a follow-up schedule in cutaneous melanoma patients: recommendations for an effective follow-up strategy. J Clin Oncol 2003; 21:520–9PubMedCrossRef
8.
Zurück zum Zitat Sylaidis P, Gordon D, Rigby H, et al. Follow-up requirements for thick cutaneous melanoma. Br J Plast Surg 1997; 50:349–53PubMedCrossRef Sylaidis P, Gordon D, Rigby H, et al. Follow-up requirements for thick cutaneous melanoma. Br J Plast Surg 1997; 50:349–53PubMedCrossRef
9.
Zurück zum Zitat McCarthy WH, Shaw HM, Thompson JF, et al. Time and frequency of recurrence of cutaneous stage I malignant melanoma with guidelines for follow-up study. Surg Gynecol Obstet 1988; 166:497–502PubMed McCarthy WH, Shaw HM, Thompson JF, et al. Time and frequency of recurrence of cutaneous stage I malignant melanoma with guidelines for follow-up study. Surg Gynecol Obstet 1988; 166:497–502PubMed
10.
Zurück zum Zitat Baughan CA, Hall VL, Leppard BJ, et al. Follow-up in stage I cutaneous malignant melanoma: an audit. Clin Oncol (R Coll Radiol) 1993; 5:174–80 Baughan CA, Hall VL, Leppard BJ, et al. Follow-up in stage I cutaneous malignant melanoma: an audit. Clin Oncol (R Coll Radiol) 1993; 5:174–80
11.
Zurück zum Zitat Basseres N, Grob JJ, Richard MA, et al. Cost-effectiveness of surveillance of stage I melanoma. A retrospective appraisal based on a 10-year experience in a dermatology department in France. Dermatology 1995; 191:199–203PubMedCrossRef Basseres N, Grob JJ, Richard MA, et al. Cost-effectiveness of surveillance of stage I melanoma. A retrospective appraisal based on a 10-year experience in a dermatology department in France. Dermatology 1995; 191:199–203PubMedCrossRef
12.
Zurück zum Zitat Poo-Hwu WJ, Ariyan S, Lamb L, et al. Follow-up recommendations for patients with American Joint Committee on Cancer Stages I–III malignant melanoma. Cancer 1999; 86:2252–8PubMedCrossRef Poo-Hwu WJ, Ariyan S, Lamb L, et al. Follow-up recommendations for patients with American Joint Committee on Cancer Stages I–III malignant melanoma. Cancer 1999; 86:2252–8PubMedCrossRef
13.
Zurück zum Zitat Regan MW, Reid CD, Griffiths RW, et al. Malignant melanoma, evaluation of clinical follow up by questionnaire survey. Br J Plast Surg 1985; 38:11–4PubMedCrossRef Regan MW, Reid CD, Griffiths RW, et al. Malignant melanoma, evaluation of clinical follow up by questionnaire survey. Br J Plast Surg 1985; 38:11–4PubMedCrossRef
14.
Zurück zum Zitat Ruark DS, Shaw HM, Ingvar C, McCarthy WH, Thompson JF. Who detects the first recurrence in stage I cutaneous melanoma? (abstract). Melanoma Res 1993; 3(Suppl 1):44CrossRef Ruark DS, Shaw HM, Ingvar C, McCarthy WH, Thompson JF. Who detects the first recurrence in stage I cutaneous melanoma? (abstract). Melanoma Res 1993; 3(Suppl 1):44CrossRef
15.
Zurück zum Zitat Weiss M, Loprinzi CL, Creagan ET, et al. Utility of follow-up tests for detecting recurrent disease in patients with malignant melanomas. JAMA 1995; 274:1703–5PubMedCrossRef Weiss M, Loprinzi CL, Creagan ET, et al. Utility of follow-up tests for detecting recurrent disease in patients with malignant melanomas. JAMA 1995; 274:1703–5PubMedCrossRef
16.
Zurück zum Zitat Kim CJ, Reintgen DS, Balch CM. The new melanoma staging system. Cancer Control 2002; 9:9–15PubMed Kim CJ, Reintgen DS, Balch CM. The new melanoma staging system. Cancer Control 2002; 9:9–15PubMed
17.
Zurück zum Zitat Blum A, Brand CU, Ellwanger U, et al. Awareness and early detection of cutaneous melanoma: an analysis of factors related to delay in treatment. Br J Dermatol 1999; 141:783–7PubMedCrossRef Blum A, Brand CU, Ellwanger U, et al. Awareness and early detection of cutaneous melanoma: an analysis of factors related to delay in treatment. Br J Dermatol 1999; 141:783–7PubMedCrossRef
18.
Zurück zum Zitat Brady MS, Oliveria SA, Christos PJ, et al. Patterns of detection in patients with cutaneous melanoma. Cancer 2000; 89:342–7PubMedCrossRef Brady MS, Oliveria SA, Christos PJ, et al. Patterns of detection in patients with cutaneous melanoma. Cancer 2000; 89:342–7PubMedCrossRef
19.
Zurück zum Zitat Epstein DS, Lange JR, Gruber SB, et al. Is physician detection associated with thinner melanomas? JAMA 1999; 281:640–3PubMedCrossRef Epstein DS, Lange JR, Gruber SB, et al. Is physician detection associated with thinner melanomas? JAMA 1999; 281:640–3PubMedCrossRef
20.
Zurück zum Zitat Schmid-Wendtner MH, Baumert J, Stange J, et al. Delay in the diagnosis of cutaneous melanoma: an analysis of 233 patients. Melanoma Res 2002; 12:389–94PubMedCrossRef Schmid-Wendtner MH, Baumert J, Stange J, et al. Delay in the diagnosis of cutaneous melanoma: an analysis of 233 patients. Melanoma Res 2002; 12:389–94PubMedCrossRef
21.
Zurück zum Zitat Lowe JB, Ball J, Lynch BM, et al. Acceptability and feasibility of a community-based screening programme for melanoma in Australia. Health Promot Int 2004; 19:437–44PubMedCrossRef Lowe JB, Ball J, Lynch BM, et al. Acceptability and feasibility of a community-based screening programme for melanoma in Australia. Health Promot Int 2004; 19:437–44PubMedCrossRef
22.
Zurück zum Zitat Richard MA, Grob JJ, Avril MF, et al. Delays in diagnosis and melanoma prognosis (I): the role of patients. Int J Cancer 2000; 89:271–9PubMedCrossRef Richard MA, Grob JJ, Avril MF, et al. Delays in diagnosis and melanoma prognosis (I): the role of patients. Int J Cancer 2000; 89:271–9PubMedCrossRef
23.
Zurück zum Zitat Kersey PA, Iscoe NA, Gapski JA, et al. The value of staging and serial follow-up investigations in patients with completely resected, primary, cutaneous malignant melanoma. Br J Surg 1985; 72:614–7PubMedCrossRef Kersey PA, Iscoe NA, Gapski JA, et al. The value of staging and serial follow-up investigations in patients with completely resected, primary, cutaneous malignant melanoma. Br J Surg 1985; 72:614–7PubMedCrossRef
24.
Zurück zum Zitat Johnson TM, Hamilton T, Lowe L. Multiple primary melanomas. J Am Acad Dermatol 1998; 39:422–7PubMedCrossRef Johnson TM, Hamilton T, Lowe L. Multiple primary melanomas. J Am Acad Dermatol 1998; 39:422–7PubMedCrossRef
25.
Zurück zum Zitat Brobeil A, Rapaport D, Wells K, et al. Multiple primary melanomas: implications for screening and follow-up programs for melanoma. Ann Surg Oncol 1997; 4:19–23PubMedCrossRef Brobeil A, Rapaport D, Wells K, et al. Multiple primary melanomas: implications for screening and follow-up programs for melanoma. Ann Surg Oncol 1997; 4:19–23PubMedCrossRef
26.
Zurück zum Zitat Ariyan S, Poo WJ, Bolognia J, et al. Multiple primary melanomas: data and significance. Plast Reconstr Surg 1995; 96:1384–9PubMedCrossRef Ariyan S, Poo WJ, Bolognia J, et al. Multiple primary melanomas: data and significance. Plast Reconstr Surg 1995; 96:1384–9PubMedCrossRef
27.
Zurück zum Zitat Dicker TJ, Kavanagh GM, Herd RM, et al. A rational approach to melanoma follow-up in patients with primary cutaneous melanoma. Scottish Melanoma Group. Br J Dermatol 1999; 140:249–54PubMedCrossRef Dicker TJ, Kavanagh GM, Herd RM, et al. A rational approach to melanoma follow-up in patients with primary cutaneous melanoma. Scottish Melanoma Group. Br J Dermatol 1999; 140:249–54PubMedCrossRef
28.
Zurück zum Zitat Martini L, Brandani P, Chiarugi C, et al. First recurrence analysis of 840 cutaneous melanomas: a proposal for a follow-up schedule. Tumori 1994; 80:188–97PubMed Martini L, Brandani P, Chiarugi C, et al. First recurrence analysis of 840 cutaneous melanomas: a proposal for a follow-up schedule. Tumori 1994; 80:188–97PubMed
29.
Zurück zum Zitat Garbe C, Schadendorf D. Surveillance and follow-up examinations in cutaneous melanoma. Onkologie 2003; 26:241–6PubMedCrossRef Garbe C, Schadendorf D. Surveillance and follow-up examinations in cutaneous melanoma. Onkologie 2003; 26:241–6PubMedCrossRef
Metadaten
Titel
Detection of First Relapse in Cutaneous Melanoma Patients: Implications for the Formulation of Evidence-Based Follow-up Guidelines
verfasst von
Anne Brecht Francken, MD
Helen M. Shaw, PhD
Neil A. Accortt, PhD
Seng-Jaw Soong, PhD
Harald J. Hoekstra, MD
John F. Thompson, MD
Publikationsdatum
01.06.2007
Verlag
Springer-Verlag
Erschienen in
Annals of Surgical Oncology / Ausgabe 6/2007
Print ISSN: 1068-9265
Elektronische ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-007-9347-2

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