Long-term follow-up for melanoma patients: is there any evidence of a benefit?

Abstract

As the incidence of melanoma and the number of melanoma survivors continues to rise, optimal surveillance strategies are needed that balance the risks and benefits of screening in the context of contemporary resource use. Detection of recurrences has important implications for clinical management. Most current surveillance recommendations for melanoma survivors are based on low-level evidence with wide variations in practice patterns and an unknown clinical impact for the melanoma survivor.

Keywords: Cost-effectiveness; Diagnostic imaging; Evidence-based surveillance; Guidelines; Melanoma; Survivorship.

Figure 1

Melanoma-specific 5-year Conditional Survival estimates stratified by disease stage. From Xing Y, Chang GJ, Hu CY, et al: Conditional survival estimates improve over time for patients with advanced melanoma: results from a population-based analysis. Cancer 2010 May 1;116(9):2234–41, with permission.

Figure 2

Markov model representing the stage-specific natural history of surgically treated melanoma. Time horizon: lifetime. λ₁₂ indicates monthly transition rate from no evidence of disease (NED) to regional recurrence; λ₁₃, monthly transition rate from NED to distant recurrence; λ₁₄, monthly transition rate from NED to death from other causes; λ₁ = λ₁₂ + λ₁₃ + λ₁₄ = monthly transition rate of NED. From Rueth NM, Xing Y, Chiang YJ, et al: Is Surveillance Imaging Effective for Detecting Surgically Treatable Recurrences in Patients With Melanoma? A Comparative Analysis of Stage-Specific Surveillance Strategies. Ann Surg, 2014 Jun;259(6):1215–22, with permission.

Figure 3

Stage-Specific Relative Increase in Life Expectancy for Imaging Surveillance Compared to Clinical Examination Alone (By Stage and Frequency). From Rueth NM, Xing Y, Chiang YJ, et al: Is Surveillance Imaging Effective for Detecting Surgically Treatable Recurrences in Patients With Melanoma? A Comparative Analysis of Stage-Specific Surveillance Strategies. Ann Surg, 2014 Jun;259(6):1215–22, with permission.