Sixty thousand new cases of invasive melanoma are diagnosed each year, and depending on the severity, many patients stand a chance of those malignancies recurring in the following five or 10 years or beyond. On Call asked dermatologists around the country about their approach to follow-up care for their melanoma patients.
In the 24 years between 1980 and 2004, the incidence of melanoma in American Caucasian women between the ages of 15 and 39 increased 50 percent. That's according to the National Cancer Institute.
On Call asked dermatologists around the country about their approach to follow-up care for their melanoma patients. We talked about the frequency of follow-up visits as well as what processes they follow to stay on top of any recurrence or development of new cancers.
Most of the doctors report starting out following a three-month follow-up schedule with intervals extended after the first year or two, but many also emphasize other factors as they try to keep their patients healthy.
Exams and testing
Susan Swetter, M.D., practices at the Palo Alto VA, Palo Alto, Calif., and the Stanford Cancer Center, Stanford, Calif. She says melanoma follow-up includes two separate issues: One is the frequency of exams, while the other covers the testing performed.
"Being a member of the NCCN (National Comprehensive Cancer Network panel), I try to hold pretty close to the guidelines, and there is a lot of latitude there. The frequency depends on the risk of recurrence and of new melanoma development. That's kind of the bottom line. Nobody says you have to see a patient every three months. It has to be individually based. That's the important message.
"Because we're an academic center, we prefer to co-manage patients with our community providers," Dr. Swetter says. "So while I, in the melanoma center, may only see stage I patients every six months, they often will see their outside dermatologist in between, and I promote that. It's a good idea."
Dr. Swetter, director of the Pigmented Lesion and Cutaneous Melanoma Clinic, also says that in patients who are asymptomatic with stage I melanoma, she doesn't generally do surveillance studies.
"The key to detecting disease recurrence is a careful review system and a clinical exam. We are trying to move practitioners away from the reflexive ordering of chest X-ray or a set of labs or, even worse, getting a PET or CT scan, which has significant radiation for asymptomatic patients," Dr. Swetter says.