Recurrences of early-stage melanoma are more often detected by patients and their physicians than by routine imaging tests, according to study published early online in the Journal of the American College of Surgeons.
"We are most concerned about patients who have stage II melanoma," said Adam C. Berger, MD, Thomas Jefferson University, Philadelphia, Pennsylvania. "They have more advanced primary melanomas, and on average, between 20% and 45% of these patients will die within 5 years. In the past, we didn't have good therapies for this type of melanoma, but new therapies mean survival continues to improve."
For the current study, which covered the years from 1996 to 2015, researchers analysed data from a multi-institution database on 581 patients with stage II melanoma and at least 1 year of follow-up.
Of the patients, 171 patients with early stage melanoma developed a recurrence (29.4%). Male sex, ulceration, and stage were significant predictors of recurrence.
"We wanted to get a break down on how we are discovering recurring melanomas," said Dr. Berger.
The question was whether it was a change a patient observed that warranted a trip to the doctor, a symptom a physician identified during a scheduled visit, or something detected with routine imaging. Study data included place of first recurrence and how recurrence was detected (patient symptom, physician exam, or routine surveillance imaging).
The analysis revealed that patient symptoms were the most frequent mode of detection, with 40% of recurrences spotted by patients, whether it was a suspicious change they felt on their skin or a symptom such as coughing blood or seizures.
Further, 30% of recurrent melanomas were identified by scheduled physician exam and 26% by surveillance imaging.
Regional nodes were the most common site of recurrence (30%), followed by lung (27%), and in-transit metastases (18%).
"The fact that imaging picked up 26% of patients with recurrence is notable because it is a little higher than what wève seen in the past, which I think reflects the current trend to do more imaging in general," said Dr. Berger. "There is a move to use CT scans and other imaging techniques as an important strategy in early recurrence detection."
Very few studies have specifically analysed recurrence and detection patterns for patients with stage II melanoma. Researchers expect the findings from this study to help reshape protocols for people diagnosed with melanoma.
"Our hope is to have some impact on future follow-up guidelines and how we think about screening for recurrent melanoma," said Dr. Berger. "Every study like this helps contribute to framing those guidelines."
Importantly, people who have been previously diagnosed with early stage melanoma need to be on the alert for symptoms of recurrence. But the take-away message from this research is that 2 heads are better than 1.
"Patients need to be aware of all of their symptoms and their body," said Dr. Berger. "But it's also important for physicians to educate patients as to what to look for and what symptoms are a cause for concern. Patients should examine their skin and the area where lymph nodes would be on a monthly basis. And if they have a symptom that doesn't go away after 2 or 3 weeks, it should be brought to a physician's attention, because that is an indicator that the melanoma has come back."
SOURCE: American College of Surgeons
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