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Vetto JT. Clinical and Imaging Follow-Up for High-Risk Cutaneous Melanoma: Current Evidence and Guidelines. Cancers (Basel) 2024; 16:2572. [PMID: 39061211 PMCID: PMC11274402 DOI: 10.3390/cancers16142572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Revised: 07/13/2024] [Accepted: 07/15/2024] [Indexed: 07/28/2024] Open
Abstract
The most recent (eighth) edition of the American Joint Committee on Cancer (AJCC) staging system divides invasive cutaneous melanoma into two broad groups: "low-risk" (stage IA-IIA) and "high-risk" (stage IIB-IV). While surveillance imaging for high-risk melanoma patients makes intuitive sense, supporting data are limited in that they are mostly respective and used varying methods, schedules, and endpoints. As a result, there is a lack of uniformity across different dermatologic and oncologic organizations regarding recommendations for follow-up, especially regarding imaging. That said, the bulk of retrospective and prospective data support imaging follow-up for high-risk patients. Currently, it seems that either positron emission tomography (PET) or whole-body computerized tomography (CT) are reasonable options for follow-up, with brain magnetic resonance imaging (MRI) preferred for the detection of brain metastases in patients who can undergo it. The current era of effective systemic therapies (ESTs), which can improve disease-free survival (DFS) and overall survival (OS) beyond lead-time bias, has emphasized the role of imaging in detecting various patterns of EST response and treatment relapse, as well as the importance of radiologic tumor burden.
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Affiliation(s)
- John T. Vetto
- Department of Surgery, Division of Surgical Oncology, Oregon Health & Science University, Portland, OR 97239, USA; ; Tel.: +1-503-494-5501
- Department of Dermatology, Oregon Health & Science University, Portland, OR 97239, USA
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Rajagopal S, Yao X, Abadir W, Baetz TD, Easson A, Knight G, McWhirter E, Nessim C, Rosen CF, Sun A, Wright FC, Petrella TM. Surveillance evaluations in patients with stage I, II, III, or resectable IV melanoma who were treated with curative intent: A systematic review. Surg Oncol 2024; 54:102077. [PMID: 38657486 DOI: 10.1016/j.suronc.2024.102077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 03/20/2024] [Accepted: 04/08/2024] [Indexed: 04/26/2024]
Abstract
PURPOSE Appropriate surveillance of patients with melanoma treated with curative intent is vital to improve patient outcomes. A systematic review was conducted to capture locoregional recurrence and metastatic disease, and to evaluate the effectiveness of various surveillance strategies. METHODS MEDLINE, EMBASE, PubMed, Cochrane Database of Systematic Reviews, and National Cancer Institute Clinical Trials Database were searched. Randomized controlled trials (RCTs) and comparative studies reporting at least one patient-related outcome were included. Exclusion criteria included: published in non-English or recruited >20 % or an uncertain percentage of non-target patients without conducting a subgroup analysis for the target patients. This review was registered at PROSPERO (CRD42021246482). RESULTS Among 17,978 publications from the literature search, one RCT and five non-randomized comparative studies were included and comprised 4016 patients. The aggregate evidence certainty was low for the RCT and very low for the comparative studies, as assessed by the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach. For patients with stage IA-IIC melanoma, a reduced follow-up schedule with clinical follow-up strategies alone may be safe and cost-effective. For stage IIC-IIIC patients, at least two serial PET/CT or whole-body CT and brain MRI imaging within a median follow-up of 31.2 months may detect 50 % of recurrences that lead to additional management, such as surgery. PET/CT may have a higher positive predictive value and lower false positive rate compared with CT alone in detecting recurrence in stage I-III patients. CONCLUSION Surveillance protocols should be based on individual risk of recurrence and established best practices when formulating follow-up strategies, as suggested by the studies reviewed. Future high-quality studies are needed to clarify the frequency of imaging follow-up strategies, especially in patients with high-risk stage II melanoma.
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Affiliation(s)
- Sudha Rajagopal
- Trillium Health Partners, Credit Valley Hospital, Peel Regional Cancer Centre, 2200 Eglinton Ave West, Mississauga, Ontario L5M 7S4, Canada.
| | - Xiaomei Yao
- Department of Oncology, Department of Health Research Methods Evidence and Impact, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4L8, Canada; Program in Evidence-Based Care, Ontario Health (Cancer Care Ontario), 711 Concession Street, Hamilton, Ontario, L8V 1C3, Canada.
| | - Wadid Abadir
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada.
| | - Tara D Baetz
- Department of Oncology, Cancer Centre of Southeastern Ontario, Kingston Health Sciences Centre, 25 King Street West, Kingston, Ontario, K7L 5P9, Canada.
| | - Alexandra Easson
- Department of Surgery, Marvelle Koffler Breast Centre, Mount Sinai Hospital, 600 University Avenue, Toronto, Ontario, M5G 1X5, Canada.
| | - Gregory Knight
- Department of Oncology, Grand River Regional Cancer Centre, Grand River Hospital, 835 King Street West, Kitchener, Ontario, N2G 1G3, Canada.
| | - Elaine McWhirter
- Department of Medical Oncology, Juravinski Cancer Centre, Hamilton Health Sciences, 699 Concession Street, Hamilton, Ontario, L8V 5C2, Canada.
| | - Carolyn Nessim
- Department of Surgery, University of Ottawa, The Ottawa Hospital, 501 Smyth Road, Ottawa, Ontario, K1H 8L6, Canada.
| | - Cheryl F Rosen
- Division of Dermatology, Toronto Western Hospital, University Health Network, University of Toronto, 399 Bathurst Street, Toronto, Ontario, M5T 2S8, Canada.
| | - Alexander Sun
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network, 610 University Avenue, Toronto, Ontario, M5G 2M9, Canada.
| | - Frances C Wright
- Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, Ontario, M4N 3M5, Canada.
| | - Teresa M Petrella
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada.
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Rajagopal S, Yao X, Abadir W, Baetz TD, Easson AM, Knight G, McWhirter E, Nessim C, Rosen CF, Sun A, Wright FC, Petrella TM. An Ontario Health (Cancer Care Ontario) Clinical Practice Guideline: Surveillance Strategies in Patients with Stage I, II, III or Resectable IV Melanoma Who Were Treated with Curative Intent. Clin Oncol (R Coll Radiol) 2024; 36:243-253. [PMID: 38336503 DOI: 10.1016/j.clon.2024.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 12/20/2023] [Accepted: 01/15/2024] [Indexed: 02/12/2024]
Abstract
AIMS To make recommendations on managing the surveillance of patients with stage I, II, III or resectable IV melanoma who are clinically free of disease following treatment with curative intent. MATERIALS AND METHODS This guideline was developed by Ontario Health's (Cancer Care Ontario's) Program in Evidence-Based Care and the Melanoma Disease Site Group (including seven medical oncologists, four surgical oncologists, three dermatologists, one radiation oncologist and one patient representative). The MEDLINE, EMBASE, Cochrane Library, PROSPERO databases and the main relevant guideline websites were searched. Internal and external reviews were conducted, with final approval by the Program in Evidence-Based Care and the Melanoma Disease Site Group. The Grading of Recommendations, Assessment, Development and Evaluation approach was followed, and the Modified Delphi method was used. RESULTS Based on the current evidence (eight eligible original study papers and four relevant guidelines) and the clinical opinions of the authors of this guideline, the initial recommendations were made. To reach 75% agreement for each recommendation, the Melanoma Disease Site Group (16 members) voted twice and one recommendation was voted on three times. After a comprehensive internal and external review process (including national and international reviewers), 12 recommendations, three weak recommendations and six qualified statements were ultimately made. CONCLUSIONS After a systematic review, a comprehensive internal and external review process and a consensus process, the current guideline has been created. The guideline authors believe that this guideline will help clinicians, patients and policymakers make well-informed healthcare decisions that will guide them in clinical melanoma surveillance and ultimately assist in improving patient outcomes.
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Affiliation(s)
- S Rajagopal
- Trillium Health Partners, Credit Valley Hospital, Peel Regional Cancer Centre, Mississauga, Ontario, Canada.
| | - X Yao
- Department of Oncology, Department of Health Research Methods Evidence and Impact, McMaster University, Hamilton, Ontario, Canada; Program in Evidence-Based Care, Ontario Health (Cancer Care Ontario), Hamilton, Ontario, Canada.
| | - W Abadir
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Ontario, Canada
| | - T D Baetz
- Cancer Centre of Southeastern Ontario, Queen's Cancer Research Institute, Kingston, Ontario, Canada
| | - A M Easson
- Department of Surgery, Marvelle Koffler Breast Centre, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - G Knight
- Department of Oncology, Grand River Regional Cancer Centre, Grand River Hospital, Kitchener, Ontario, Canada
| | - E McWhirter
- Department of Medical Oncology, Juravinski Cancer Centre, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - C Nessim
- Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - C F Rosen
- Division of Dermatology, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - A Sun
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - F C Wright
- Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - T M Petrella
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
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