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Podlipnik S, Carrera C, Sánchez M, Arguis P, Olondo ML, Vilana R, Rull R, Vidal-Sicart S, Vilalta A, Conill C, Malvehy J, Puig S. Performance of diagnostic tests in an intensive follow-up protocol for patients with American Joint Committee on Cancer (AJCC) stage IIB, IIC, and III localized primary melanoma: A prospective cohort study. J Am Acad Dermatol 2016; 75:516-524. [PMID: 27183845 DOI: 10.1016/j.jaad.2016.02.1229] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 02/22/2016] [Accepted: 02/29/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND There is no international consensus on optimal follow-up schedules and which supplementary tests should be used after resection of a primary melanoma. OBJECTIVE We sought to analyze the performance of the follow-up components and identify procedures that detect melanoma metastasis earlier. METHODS This was a prospective cohort from 290 consecutive patients given a diagnosis of stage IIB, IIC, and III melanoma. Patients were followed up with an intensive protocol based on imaging studies (computed tomography of the chest, abdomen, and pelvis, and brain magnetic resonance imaging), periodic laboratory tests, regular physical examinations, and patient self-examinations. RESULTS A total of 2382 clinical examinations and 3069 imaging tests were performed. The patients completed 899.8 person-years of follow-up, with a median of 2.5 years. In all, 115 recurrences in 290 patients were recorded, of which computed tomography detected 48.3%; brain magnetic resonance imaging, 7.6%; laboratory test, 2.5%; physician, 23.7%; and patient, 17.8%. LIMITATIONS Patients with stage III melanoma were not systematically classified into subgroups and overall survival was not evaluated. CONCLUSION We observed that this intensive monitoring is appropriate for early detection of recurrence in stage IIB, IIC, and III melanoma. Prompt diagnosis of metastasis and the recent development of new therapeutic targets may improve overall survival.
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Affiliation(s)
- Sebastian Podlipnik
- Dermatology Department, Melanoma Unit, Hospital Clinic, and Ititut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red (CIBER) on Rare Disease, Instituto de Salud Carlos III, Barcelona, Spain
| | - Cristina Carrera
- Dermatology Department, Melanoma Unit, Hospital Clinic, and Ititut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red (CIBER) on Rare Disease, Instituto de Salud Carlos III, Barcelona, Spain
| | - Marcelo Sánchez
- Radiology Service, Melanoma Unit, Hospital Clinic, and Ititut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Pedro Arguis
- Radiology Service, Melanoma Unit, Hospital Clinic, and Ititut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Maria L Olondo
- Radiology Service, Melanoma Unit, Hospital Clinic, and Ititut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Ramon Vilana
- Radiology Service, Melanoma Unit, Hospital Clinic, and Ititut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Ramon Rull
- Surgery Department, Melanoma Unit, Hospital Clinic, and Ititut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Sergi Vidal-Sicart
- Nuclear Medicine Service, Melanoma Unit, Hospital Clinic, and Ititut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Antonio Vilalta
- Dermatology Department, Melanoma Unit, Hospital Clinic, and Ititut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Carles Conill
- Radiotherapy Oncology, Melanoma Unit, Hospital Clinic, and Ititut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Josep Malvehy
- Dermatology Department, Melanoma Unit, Hospital Clinic, and Ititut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red (CIBER) on Rare Disease, Instituto de Salud Carlos III, Barcelona, Spain
| | - Susana Puig
- Dermatology Department, Melanoma Unit, Hospital Clinic, and Ititut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red (CIBER) on Rare Disease, Instituto de Salud Carlos III, Barcelona, Spain.
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