Abstract
Background
Currently, there is a general lack of consensus regarding optimal strategy and imaging during follow-up for patients suffering from melanoma.
Objectives
Our aim was to analyse the utility of various imaging procedures, in particular CT scans, during the follow-up of patients with different stages of melanoma.
Materials & Methods
A retrospective analysis of the medical records of patients suffering from melanoma diagnosed between 2001 and 2011 was carried out at the Department of Dermatology, University of Pécs. Patients with in situ (Stage 0) and metastatic (Stage IV) melanoma were excluded from the analysis, as well as patients who succumbed during the first three years of follow-up.
Results
In total, 649 melanoma patients met the inclusion criteria. During the entire follow-up period, 90 recurrences were detected. The vast majority (n = 71; 79%) of the total metastatic cases (n = 90) were diagnosed within the first three years. In 35% of the cases, metastases were detected by CT. Although more than 66% of the CT scans were performed for Stage I patients, only three cases were positive (0.1%) within this population.
Conclusion
On the basis of our results, intensive radiological work-up is not deemed necessary during the surveillance of patients in the early stages (IA–IIA) of melanoma. Initial and regular follow-up imaging examinations (preferably CT scans) may be recommended from Stage IIB of the disease.
Article PDF
Similar content being viewed by others
Explore related subjects
Discover the latest articles, news and stories from top researchers in related subjects.Avoid common mistakes on your manuscript.
References
World Health Organization. Ultraviolet radiation and the INTER-SUN Programme. (accessed 11 Dec 2016).
Balch CM, Gershenwald JE, Soong SJ, et al. Final version of 2009 AJCC melanoma staging and classification. J Clin Oncol 2009; 27: 6199–206.
Dickson PV, Gershenwald JE. Staging and prognosis of cutaneous melanoma. Surg Oncol Clin N Am 2011; 20: 1–17.
Howlader N, Noone AM, Krapcho M, et al. Surveillance, Epidemiology, and End Results (SEER) Cancer Statistics Review, 1975–2014. National Cancer Institute. Bethesda, MD. Available at: https://seer.cancer.gov/archive/csr/1975_2014/ (accessed 2 Apr 2018).
Mrazek AA, Chao C. Surviving Cutaneous Melanoma: A Clinical Review of Follow-up Practices, Surveillance, and Management of Recurrence. Surg Clin North Am 2014; 94: 989–1002.
Trotter SC, Sroa N, Winkelmann RR, Olencki T, Bechtel M. A Global Review of Melanoma Follow-up Guidelines. J Clin Aesthet Dermatol 2013; 6: 18–26.
Francken AB, Hoekstra HJ. Follow-Up of Melanoma Patients: The Need for Evidence-Based Protocols. Ann Surg Oncol 2009; 16: 804–5.
Garbe C, Paul A, Kohler-Späth 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: 520–9.
De Angelis R, Sant M, Coleman MP, et al. EUROCARE-5 Working Group. Cancer survival in Europe 1999–2007 by country and age: results of EUROCARE-5-a population-based study. Lancet Oncol 2014; 15: 23–34.
Edge SB, Compton CC. The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol 2010; 17: 1471–4.
Dummer R, Hauschild A, Lindenblatt N, Pentheroudakis G, Keilholz U. Cutaneous Melanoma: ESMO Clinical Practice Guidelines. Ann Oncol 2015; 26: 126–32.
Podlipnik S, Carrera C, Sanchez M, et al. Performance of diagnostic tests in an intensive follow-up protocol for patients with American Joint Committee on Cancer (AJCC) stage IIB, IIC, and III localized primary melanoma: A prospective cohort study. J Am Acad Dermatol 2016; 75: 516–24.
Davis SD. CT evaluation for pulmonary metastases in patients with extrathoracic malignancy. Radiology 1991; 180: 1–12.
Henschke CI, McCauley DI, Yankelevitz DF, et al. Early Lung Cancer Action Project: overall design and findings from baseline screening. Lancet 1999; 354: 99–105.
Diederich S, Das M. Solitary pulmonary nodule: detection and management. Cancer Imaging 2006; 6: S42–6.
Salama AK, de Rosa N, Scheri RP, et al. Hazard-Rate Analysis and Patterns of Recurrence in Early Stage Melanoma: Moving towards a Rationally Designed Surveillance Strategy. PLoS One 2013; 8: e57665.
Francken AB, Accortt NA, Shaw HM, et al. Follow-up schedules after treatment for malignant melanoma. Br J Surg 2008; 95: 1401–7.
Svedman FC, Pillas D, Taylor A, Kaur M, Linder R, Hansson J. Stage-specific survival and recurrence in patients with cutaneous malignant melanoma in Europe-a systematic review of the literature. Clin Epidemiol 2016; 8: 109–22.
Gershenwald JE, Scolye RA. Melanoma Staging: American Joint Committee on Cancer (AJCC) 8th Edition and Beyond. Ann Surg Oncol 2018; 8: 2105–10.
Berman C, Reintgen D. Radiologic imaging in malignant melanoma: a review. Semin Surg Oncol 1993; 9: 232–8.
Xing Y, Bronstein Y, Ross MI, et al. Contemporary diagnostic imaging modalities for the staging and surveillance of melanoma patients: a meta-analysis. J Natl Cancer Inst 2011; 103: 129–42.
Gellén E, Sántha O, Janka E, et al. Diagnostic accuracy of (18) F-FDG-PET/CT in early and late stages of high-risk cutaneous malignant melanoma. J Eur Acad Dermatol Venereol 2015; 29: 1938–44.
Park TS, Phan GQ, Yang JC, et al. Routine Computer Tomography Imaging for the Detection of Recurrences in High-Risk Melanoma Patients. Ann Surg Oncol 2017; 24: 947–51.
Leiter U, Marghoob AA, Lasithiotakis K, et al. Costs of the detection of metastases and follow-up examinations in cutaneous melanoma. Melanoma Res 2009; 19: 50–7.
Pope WB. Brain metastases: neuroimaging. Handb Clin Neurol 2018; 149: 89–112.
Deike-Hofmann K, Thünemann D, Breckwoldt MO, et al. Sensitivity of different MRI sequences in the early detection of melanoma brain metastases. PLoS One 2018; 13: e0193946.
Pearce MS, Salotti JA, Little MP, et al. Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumors: A retrospective cohort study. Lancet 2012; 380: 499–505.
Berrington de Gonzalez A, Mahesh M, et al. Projected cancer risks from computed tomography scans performed in the United States in 2007. Arch Intern Med 2009; 169: 2071–7.
Brenner DJ, Hall EJ. Computed tomography: an increasing source of radiation exposure. N Engl J Med 2007; 357: 2277–84.
Wen JC, Sai V, Straatsma BR, McCannel TA. Radiation-related cancer risk associated with surveillance imaging for metastatis from choroideal melanoma. JAMA Ophthalmol 2013; 131: 56–61.
Francken AB, Shaw HM, Accortt NA, Soong SJ, Hoekstra HJ, Thompson JF. Detection of first relapse in cutaneous melanoma patients: implications for the formulation of evidence-based follow-up guidelines. Ann Surg Oncol 2007; 14: 1924–33.
Francken AB, Bastiaannet E, Hoekstra HJ. Follow-up in patients with localised primary cutaneous melanoma. Lancet Oncol 2005; 6: 608–21.
Weiss M, Loprinzi CL, Creagan ET, Dalton RJ, Novotny P, O’Fallon JR. Utility of follow-up tests for detecting recurrent disease in patients with malignant melanomas. JAMA 1995; 274: 1703–5.
National Comprehensive Cancer Network Inc. NCCN Clinical Practice Guidelines in oncology. Available at: www.nccn.org/professionals/physician_gls/pdf/cutaneous_melanoma.pdf (accessed 19 Dec 2019).
Damude S, Hoekstra-Weebers JE, Francken AB, Ter Meulen S, Bastiaannet E, Hoekstra HJ. MELFO-Study: Prospective, Randomized, Clinical Trial for the Evaluation of a Stage-adjusted Reduced Follow-up Schedule in Cutaneous Melanoma Patients-Results after 1 Year. Ann Surg Oncol 2016; 23: 2762–71.
Nakamura Y, Kitano S, Takahashi A, et al. Nivolumab for advanced melanoma: pretreatment prognostic factors and early outcome markers during therapy. Oncotarget 2016; 7: 77404–15.
Acknowledgements and disclosures
Acknowledgements: We wish to thank Dr. Zita Battyáni, MD, PhD for the conscientious work in the surveillance of melanoma patients, as well as the medical assistants (Ms. Andrea Kiss, Ms. Beatrix Gyurita and Ms. Bernadett Csizmadia) for organizing the examinations. Funding/support: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Conflicts of interest: none. IRB Approval status: The study received approval from the Regional and Institutional Research Ethics Committee of the Medical School, Clinical Center, University of Pécs (IRB number: AOK/2018/7356).
Author information
Authors and Affiliations
Corresponding author
About this article
Cite this article
Pozsgai, M., Németh, K., Oláh, P. et al. The significance of imaging examinations during follow-up for malignant melanoma. Eur J Dermatol 31, 357–363 (2021). https://doi.org/10.1684/ejd.2021.4054
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1684/ejd.2021.4054