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Recommendations for an Effective Follow-Up Strategy in Melanoma Patients Should Be Tailored to the Investigations Performed During Initial Staging

Service de Dermatologie, Hôpital Ambroise Paré, Assistance Publique-Hôpitaux de Paris, Université Versailles-Saint Quentin en Yvelines, Boulogne 92104 Cedex, France

To the Editor: In a recent paper, Garbe et al¹ have published an impressive study of 2,008 consecutive patients with stage I to IV cutaneous melanoma who were prospectively followed up during a "window period" of 25 months with regular clinical, lymph node, and liver sonographies and chest x-ray evaluations. This is truly the first prospective cohort study conducted so far that evaluates the various procedures used in the follow-up of patients with cutaneous melanoma. Recommendations for an effective follow-up strategy are outlined, which are for the first time based on a correctly designed study.

However, despite the numerous figures given in the paper, I was unable to calculate the false-negative rate of this follow-up strategy because information on the outcome of patients at the end of the study window period is missing. Whether some patients without progression at their last follow-up visit experienced melanoma progression before the next scheduled visit outside the study period should be detailed.

I was also unable to precisely delineate individually the value of each recommended evaluation procedure. This information is of importance; follow-up strategies may vary with time. For example, patients with negative sentinel lymph node biopsy have a considerably reduced probability of lymph node progression,² and it would be interesting to estimate the value of follow-up with lymph node sonography in such patients. At least for clinical evaluation, lymph-node sonography, and blood tests (which are recommended procedures for patients with stage I or II melanomas), the total number of true positives, false positives, true negatives and false negatives (the latter being defined by occurrence of progression before the next scheduled follow-up visit) should be published. Such information should be easily extracted from the huge database constructed for this study.

AUTHOR’S DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST

The author indicated no potential conflicts of interest.

REFERENCES

1. 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 21:520–529, 2003[Abstract/Free Full Text]

2. Gershenwald JE, Colome MI, Lee JE, et al: Patterns of recurrence following a negative sentinel lymph node biopsy in 243 patients with stage I or II melanoma. J Clin Oncol 16:2253–2260, 1998[Abstract]

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