Journal of Clinical Oncology, Vol 21, Issue 3
(February), 2003: 520-529
© 2003 American Society for Clinical Oncology
Prospective Evaluation of a Follow-Up Schedule in Cutaneous Melanoma Patients: Recommendations for an Effective Follow-Up Strategy
Claus Garbe,
Andrena Paul,
Hanna Kohler-Späth,
Ulf Ellwanger,
Waltraud Stroebel,
Monika Schwarz,
Bettina Schlagenhauff,
Friedegund Meier,
Birgit Schittek,
Hans-Juergen Blaheta,
Andreas Blum,
Gernot Rassner
From the Department of Dermatology, Skin Cancer Program, Eberhard-Karls-University of Tuebingen; and Central Malignant Melanoma Registry of the German Society of Dermatology, Tuebingen, Germany.
Address reprint requests to Claus Garbe, MD, Professor of Dermatology, Department of Dermatology, Eberhard-Karls-University, Liebermeisterstrasse 25, 72076 Tuebingen, Germany; email: claus.garbe{at}med.uni-tuebingen.de.
Purpose: To prospectively examine and evaluate the results of follow-up procedures in a large cohort of cutaneous melanoma patients.
Patients and Methods: This was a prospective study in 2,008 consecutive patients with stage I to IV cutaneous melanoma from 1996 to 1998 on the yield of stage-appropriate follow-up examinations according to the German guidelines. Documentation of patient and follow-up data comprised patient demography, primary tumor specifics, and any clinical and technical examinations performed. The detection of metastasis was classified as early or late, and the means of their detection and the resulting overall survival probabilities were examined.
Results: A total of 3,800 clinical examinations and 12,398 imaging techniques were documented. Sixty-two second primary melanomas in 46 patients and 233 disease recurrences in 112 patients were detected during this time. In stage I to III disease, physical examination was responsible for the discovery of 50% of all recurrences. In the primary tumor stages, 21% of all recurrences were discovered by lymph node sonography, with the majority being classified as early detection. Forty-eight percent of the recurrences were classified as early detection, and these patients had a significant benefit of overall survival probability.
Conclusion: The results of our study suggest that an elaborated follow-up schedule in cutaneous melanoma is suitable for the early detection of second primary melanomas and early recurrences. The intensity of clinical and technical examinations can be reduced during follow-up of patients in the primary tumor stages and may be intensified in locoregional disease. Recommendations for an effective follow-up strategy are outlined.
Supported by grant no. M3/95/Ga I from the Deutsche Krebshilfe, Bonn, Germany.
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