PubMed | Sydney Melanoma Unit
Type: Journal Article | Journal: Journal of clinical oncology : official journal of the American Society of Clinical Oncology | Year: 2016
7546 Background: The value of follow-up in cutaneous melanoma patients is controversial, and no consensus exists regarding the appropriate frequency of follow-up visits. The aim of this study was to investigate the detection of melanoma recurrences, by patient or doctor, with the ultimate goal of formulating evidence-based guidelines for follow-up.Patients who presented to the Sydney Melanoma Unit (SMU) with a first recurrence between Jul 2002 and Feb 2003 were prospectively selected and interviewed by telephone regarding the detection of their recurrence (Group A). Information for patients who could not be interviewed was retrieved from their medical records (Group B). Patient demographics and pathologic features of their primary melanoma, as well as factors relating to their last follow-up visit and the recurrence, were obtained from the SMU database. Univariate analysis and multivariate logistic regression were performed to examine factors related to the person who detected the recurrence.227 patients (85 women), median age 63 (8-94) years, were included (Group A 177, Group B 50). AJCC stage distribution was Stage I - 62 (28.4%), Stage II - 103 (47.2%), Stage III - 46 (21.1%) and Stage IV - 7 (3.2%) (9 missing values). The distribution of recurrence types was local - 24 (10.6%), intransit - 36 (15.9%), regional node - 103 (45.4%) and distant - 64 (28.2%). 74.5% of all recurrences were detected by the patient (164). No statistical difference was found between Group A and B. The median time between last follow-up visit and recurrence detection was 4 (3-64) months. Symptomatology (specific or non-specific) related to the recurrence was the only independent predictor of detection by the patient (p=0.0001). No other clinical, primary melanoma pathology or recurrence related factors were found as predictors of the person detecting the recurrence.Three-quarters of first recurrences were detected by the patient, despite frequent follow-up visits. Patient-detected recurrences could not be predicted on the basis of clinical, demographic or pathologic variables. These findings should be considered when planning follow-up for individual patients. No significant financial relationships to disclose.