Follow-up in patients with localised primary cutaneous melanoma.
Follow-up services for patients with localised cutaneous melanoma are widely discussed but there is no international consensus. Our aim was to discuss frequency and duration of follow-up, type of health professional involved, optimum intensity of routine investigation, and patients' satisfaction with follow-up. Searches of the published work were directed at publications between January, 1985, and February, 2004 on recurrences, subsequent primary melanoma, routine tests, and patients' satisfaction. In a selection of 72 articles, 2142 (6.6%) recurrences were reported, 62% of which were detected by the patients themselves. 2.6% of patients developed a subsequent primary melanoma. Most investigators do not support high-intensity routine follow-up investigations. Of the various follow-up investigations requested by physicians, only medical history and physical examination seem to be cost effective. Lymph-node sonography seems to be a promising method for detection, although survival benefit remains to be proven. Patients were found to be anxious about follow-up visits, although other research showed that provision of information to patients was much appreciated. Published work on the follow-up of patients with cutaneous melanoma has mainly been retrospective and descriptive. Recommendations can be given with only a low grade of evidence. For meaningful guidelines to be developed, prospective, high-quality methodological research is needed.
Francken
Anne Brecht
AB
Division of Surgical Oncology, University of Groningen, University Medical Centre Groningen, Groningen, Netherlands.
Bastiaannet
Esther
E
Hoekstra
Harald J
HJ
D003365:Costs and Cost Analysis; D019317:Evidence-Based Medicine; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D008545:Melanoma / Q000191:economics / Q000473:pathology*; D009362:Neoplasm Metastasis / Q000175:diagnosis; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis; D017060:Patient Satisfaction; D010808:Physical Examination / Q000191:economics; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011379:Prognosis; D011788:Quality of Life; D012878:Skin Neoplasms / Q000191:economics / Q000473:pathology*; D016019:Survival Analysis; D016896:Treatment Outcome