title: Method of detection of initial recurrence of stage II/III cutaneous melanoma: analysis of the utility of follow-up staging.
abstract: BACKGROUND
  The follow-up of patients with cutaneous melanoma is controversial. Current recommendations suggest routine history and physical examination every 3 to 6 months for the first 3 years and correlate studies including laboratory tests and radiographic imaging. However, the utility of these recommendations are unclear. The purpose of this study was to determine the impact of routine imaging on the method of detection of first recurrence in patients with stage II and sentinel lymph node-positive stage III melanoma.
  
  
  METHODS
  We analyzed a prospective database of all cutaneous melanoma patients treated at our institution from 1997 to 2005 who had at least 2 years of follow-up. The method of detection of initial recurrence was analyzed.
  
  
  RESULTS
  One hundred eighteen patients with stage II (n = 83) or III (n = 35) melanoma who were followed for at least 2 years were identified. Forty-three of these patients developed recurrence (median time to recurrence, 14 months). Site of first recurrence was as follows: 4 local, 17 in transit, 7 regional lymph node, and 15 distant. Twenty-nine recurrences (67%) were either patient detected or symptomatic. Eleven (26%) were detected by the physician at routine follow-up. Only three (7%) were identified by imaging (two chest X-ray and one brain magnetic resonance imaging) in an otherwise asymptomatic patient.
  
  
  CONCLUSIONS
  Two-thirds of all initial recurrences of cutaneous melanoma were either detected by a patient or were symptomatic, with most of the remainder detected during routine physical examination. Routine imaging added little value in the detection of initial recurrence.
authors.affiliation: Department of Surgery and The Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7213, USA. mmeyers@med.unc.edu
authors.forename: Michael O
authors.initials: MO
authors.lastname: Meyers
authors.forename: Jen Jen
authors.initials: JJ
authors.lastname: Yeh
authors.forename: Jill
authors.initials: J
authors.lastname: Frank
authors.forename: Patricia
authors.initials: P
authors.lastname: Long
authors.forename: Allison M
authors.initials: AM
authors.lastname: Deal
authors.forename: Keith D
authors.initials: KD
authors.lastname: Amos
authors.forename: David W
authors.initials: DW
authors.lastname: Ollila
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008545:Melanoma / Q000175:diagnosis* / Q000473:pathology; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis*; D009367:Neoplasm Staging; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000175:diagnosis* / Q000473:pathology; D055815:Young Adult