Cost-effectiveness of surveillance of stage I melanoma. A retrospective appraisal based on a 10-year experience in a dermatology department in France.
BACKGROUND
There is no agreement about surveillance after resection of a stage I melanoma.


OBJECTIVE
We assessed the cost-effectiveness of this surveillance.


METHODS
Out of 912 patients with stage I (and Clark's level > or = II) melanoma examined from 1981 to 1991, only 528 were regularly followed in our department.


RESULTS
115 out of 528 relapsed; 33% were detected by the patient himself, 16% by the referring physician and 39% were detected in our department. Chest X-ray or abdomen ultrasonography revealed only 10% of relapses; CT scans were useless. There was a huge gap between the cost-effectiveness of clinical examinations and radiology. The time between relapse and the last check-up in our department was less than 4 months in one third of the metastases.


CONCLUSIONS
In stage I melanoma, only clinical examination is really cost-effective in the detection of metastases. However, many metastases are likely to become prominent between two examinations if patients are examined less than 3 times a year. A progressive decrease in frequency is thus not advisable, until the risk is considered low enough to stop follow-up.
Bassères
N
N
Laboratoire d'Investigations sur les Maladies de la Peau, Hôpital Ste-Marguerite, Marseille, France.
Grob
J J
JJ
Richard
M A
MA
Thirion
X
X
Zarour
H
H
Noe
C
C
Collet-Vilette
A M
AM
Lota
I
I
Bonerandi
J J
JJ
D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D005602:France; D006801:Humans; D008207:Lymphatic Metastasis / Q000473:pathology / Q000517:prevention & control; D008297:Male; D008545:Melanoma / Q000000981:diagnostic imaging / Q000191:economics* / Q000517:prevention & control* / Q000556:secondary; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging / Q000191:economics / Q000517:prevention & control; D009367:Neoplasm Staging; D011159:Population Surveillance; D013902:Radiography, Thoracic / Q000191:economics; D012189:Retrospective Studies; D012307:Risk Factors; D012878:Skin Neoplasms / Q000000981:diagnostic imaging / Q000191:economics* / Q000517:prevention & control*; D014057:Tomography, X-Ray Computed / Q000191:economics; D014463:Ultrasonography / Q000191:economics