title: Optimizing the frequency of follow-up visits for patients treated for localized primary cutaneous melanoma.
abstract: OBJECTIVE
  To develop more evidence-based guidelines for the frequency of patient follow-up after treatment of localized (American Joint Committee on Cancer [AJCC] stage I or II) melanoma.
  
  
  METHODS
  We used data from Melanoma Institute Australia on an inception cohort of 3,081 consecutive patients first diagnosed with stage I or II melanoma between January 1985 and December 2009. Kaplan-Meier curves and Cox models were used to characterize the time course and predictors for recurrence and new primaries. We modeled the delay in diagnosis of recurrence or new primary as well as the number of monitoring visits required using two monitoring schedules: first, according to 2008 Australian and New Zealand guidelines and, second, with fewer visits, especially for those at lowest risk of recurrence.
  
  
  RESULTS
  For every 1,000 patients beginning follow-up, 229 developed recurrence and 61 developed new primary within 10 years. There was only a small difference in modeled delay in diagnosis (extra 44.9 and 9.6 patients per 1,000 for recurrence and new primary, respectively, with delay greater than 2 months) using a schedule that requires far fewer visits (3,000 fewer visits per 1,000 patients) than recommended by current guidelines. AJCC substage was the most important predictor of recurrence, whereas age and date of primary diagnosis were important predictors of developing new primary.
  
  
  CONCLUSIONS
  By providing less intensive monitoring, more efficient follow-up strategies are possible. Fewer visits with a more focused approach may address the needs of patients and clinicians to detect recurrent or new melanoma.
authors: School of Public Health, The University of Sydney, New South Wales, Australia. robin.turner@sydney.edu.au
authors: Robin M
authors: RM
authors: Turner
authors: Katy J L
authors: KJ
authors: Bell
authors: Rachael L
authors: RL
authors: Morton
authors: Andrew
authors: A
authors: Hayen
authors: Anne Brecht
authors: AB
authors: Francken
authors: Kirsten
authors: K
authors: Howard
authors: Bruce
authors: B
authors: Armstrong
authors: John F
authors: JF
authors: Thompson
authors: Les
authors: L
authors: Irwig
mesh_terms: D000359:Aftercare / Q000379:methods* / Q000592:standards; D001071:Appointments and Schedules; D001315:Australia / Q000453:epidemiology; D015331:Cohort Studies; D005500:Follow-Up Studies; D019983:Guideline Adherence; D006801:Humans; D008545:Melanoma / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000453:epidemiology; D009367:Neoplasm Staging; D009819:Office Visits / Q000706:statistics & numerical data; D011379:Prognosis; D012307:Risk Factors; D012878:Skin Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery