Prevention with Melanoma/Follow Up
AAD Recommendations for follow-up care in patients with melanoma
- Physician exam 1-4 times a year for 2 years, then 1-2 times a year. Office examination should include a thorough history and physical exam
Rationale: The majority of metastases occur in the first 3-5 years after removal of the primary tumor.
- Patient education on self-examination of the skin and lymph nodes is of primary importance.
Rationale: Several international studies have shown that patients are the ones who find new skin lesions and swollen lymph nodes. Patients can watch for changes in existing moles and new symptoms in their body if they are educated in what to look for and when to see the doctor. The earlier a diagnosis is made, the less involved is the treatment and the better the prognosis.
- The findings during the physical exam should dictate the need for laboratory and radiological testing
Rationale:Routine lab tests and imaging studies have not proved to be of value in asymptomatic primary cutaneous melanomas # 4mm. Chest x-ray and LDH are optional. A large German study (Garbe, 2003) recommended the use of lymph node sonography for early diagnosis of lymph node and in-transit metastasis with approximately one-third of new tumors being identified by this method before they were felt on exam. Lymph node sonography is easy to perform, takes little time, and is less costly than PET scanning. For areas that are not accessible by physical exam, CT scans are the image of choice. Blood tests have been found to be of little use in early diagnosis. In later metastases, LDH, alkaline phosphatase, and serum protein S100B have been found to be of some value. New knowledge gained from sentinel lymph node biopsy research will help dictate what future tests will be of value. These recommendations are based on studies where the majority of patients did not receive SLNB.
- Frequency of follow-up appointments and tests performed are based on a number of factors such as:
- Tumor thickness
- Multiple melanomas
- Presence of clinically atypical nevi
- Family history of melanoma
- Level of anxiety
- Patient’s ability to recognize signs and symptoms of melanoma
- Weight loss
- Decreased appetite
- Chest pain
- Hemoptysis (coughing up blood)
- Abdominal pain
- Balance problems
- Local weakness
- Memory disturbances
- Visual disturbances
- Mood swings
- Focal CNS symptoms
- Bone pain (e.g. spine, hip)
- Abdominal pain
- Color change
- “Swollen glands”
- Non-healing/bleeding skin lesion(s)
- New pigmented skin lesion(s)
- Easy bruising
*Adapted from Johnson TM, Chang A, Redman B, Rees R, Bradford C, Riba M, et al. Management of melanoma with a multidisciplinary melanoma clinic model. J Am Acad Dermatol 2000;42:820-6.
It goes without saying that all of the sun protection precautions listed under “Prevention for Everyone” should be followed by patients who have melanoma.