title: Prospective evaluation of follow-up in melanoma patients in Germany - results of a multicentre and longitudinal study.
abstract: BACKGROUND
  Patient numbers requiring long-term melanoma surveillance are constantly rising. Surveillance is costly and guideline recommendations vary substantially.
  
  
  METHODS
  In this German nationwide study, information on surveillance and treatment of patients diagnosed with melanoma and melanoma in situ (MMis) between April and June 2008 was prospectively collected over four years. Additionally, patient self-report questionnaires were evaluated to assess anxiety, depression, health-related quality of life, socio-demographic information and use of disease specific health information sources at year 4 after primary diagnosis.
  
  
  RESULTS
  Complete data was available for 668 patients from 67 centres, of whom 96.0% were in regular melanoma surveillance. In year 3-4 of surveillance, only 55.6% of locoregionary metastases were detected during surveillance visits. Only 33.3% were self-detected by the patient even though 69.4% were documented as being clinically visible or palpable. Costs of 4year surveillance of 550 patients without tumour recurrence (stage I-IIC and MMis) accumulated to 228,155.75 €. Guideline-adherence for follow-up frequency, lymph node ultrasound, S100 serum level tests and diagnostic imaging recommendations was approximately 60% in year 3-4 of surveillance. Multivariate regression analysis showed that certain patient/tumour characteristics and regional differences were significantly associated with guideline deviations. The percentage of patients who exceeded published cut-off scores indicating clinically relevant symptoms of anxiety and depression were significantly increased. Patients frequently reported lack of psychosocial support and education but ascribed great importance to these.
  
  
  CONCLUSIONS
  We recommend further reduction of melanoma follow-up in low-risk melanoma patients and improvement of psycho-social support and patient education for all melanoma patients.
authors: Dept. of Dermatology, University Hospital Essen, University of Duisburg-Essen, Essen, Hufelandstr. 55, 45122 Essen, Germany. Electronic address: elisabeth.livingstone@uk-essen.de.
authors: E
authors: E
authors: Livingstone
authors: Institute of Medical Psychology and Behavioral Immunobiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45122 Essen, Germany.
authors: C
authors: C
authors: Krajewski
authors: Dept. of Dermatology, University Tübingen, Liebermeisterstr. 25, 72076 Tübingen, Germany.
authors: T K
authors: TK
authors: Eigentler
authors: Alcedis GmbH, Winchesterstr. 3, 35394 Gießen, Germany.
authors: C
authors: C
authors: Windemuth-Kieselbach
authors: Institute of Medical Psychology and Behavioral Immunobiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45122 Essen, Germany.
authors: S
authors: S
authors: Benson
authors: Institute of Medical Psychology and Behavioral Immunobiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45122 Essen, Germany.
authors: S
authors: S
authors: Elsenbruch
authors: Dept. of Dermatology, University Hospital Schleswig-Holstein, Campus Kiel, Schittenhelmstr. 7, 24105 Kiel, Germany.
authors: A
authors: A
authors: Hauschild
authors: Dept. of Dermatology Kassel, Clinical Centre Kassel, Mönchebergstr. 41, 34125 Kassel, Germany.
authors: R
authors: R
authors: Rompel
authors: Dept. of Dermatology, University Medical Centre Freiburg, Hauptstr. 7, 79104 Freiburg, Germany.
authors: F
authors: F
authors: Meiss
authors: Dept. of Dermatology, University Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany.
authors: A
authors: A
authors: Mauerer
authors: Dept. of Dermatology, University Hospital Schleswig-Holstein, Campus Kiel, Schittenhelmstr. 7, 24105 Kiel, Germany.
authors: K C
authors: KC
authors: Kähler
authors: Dept. of Dermatology, Clinical Centre Ludwigshafen, Bremserstr. 79, 67073 Ludwigshafen, Germany.
authors: E
authors: E
authors: Dippel
authors: Dept. of Dermatology, Ruhr-University Bochum, Gudrunstr. 56, 44791 Bochum, Germany.
authors: K
authors: K
authors: Möllenhoff
authors: Dept. of Dermatology, Ludwig-Maximilians University Munich, Frauenlobstrasse 9-11, 80337 München, Germany.
authors: K
authors: K
authors: Kilian
authors: Dept. of Dermatology, Elbekliniken Stade-Buxtehude GmbH, Am Krankenhaus 1, 21614 Buxtehude, Germany.
authors: P
authors: P
authors: Mohr
authors: Skin Cancer Unit, German Cancer Research Centre (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany; Department of Dermatology, Venereology and Allergology, University Medical Centre Mannheim, Ruprecht-Karl University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.
authors: J
authors: J
authors: Utikal
authors: Dept. of Dermatology, University Hospital Essen, University of Duisburg-Essen, Essen, Hufelandstr. 55, 45122 Essen, Germany.
authors: D
authors: D
authors: Schadendorf
mesh_terms: D000328:Adult; D000368:Aged; D018450:Disease Progression; D055088:Early Detection of Cancer; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D019983:Guideline Adherence; D007722:Health Knowledge, Attitudes, Practice; D054625:Healthcare Disparities; D006801:Humans; D008134:Long-Term Care / Q000592:standards; D008137:Longitudinal Studies; D008297:Male; D008495:Medical Oncology / Q000592:standards; D008545:Melanoma / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology / Q000556:secondary / Q000628:therapy*; D008875:Middle Aged; D010353:Patient Education as Topic; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016353:Self-Examination; D012878:Skin Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology / Q000523:psychology / Q000628:therapy*; D012944:Social Support; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome
keywords: Cost-effectiveness; Costs; Follow-up; Guideline; Melanoma; Patient education; Psychosocial support; Recurrence; Surveillance