Follow-up recommendations for patients with American Joint Committee on Cancer Stages I-III malignant melanoma

BACKGROUND. Guidelines for follow-up of melanoma patients are not establish ed. In 1987, a follow-up protocol was instituted at the Yale Melanoma Unit to improve upon the detection of disease recurrence in patients with Americ an Joint Committee on Cancer Stage I-III cutaneous melanoma. The follow-up protocol consists of a patient education program and a surveillance schedul e based on stage of disease. METHODS, The authors retrospectively reviewed the records of 373 patients w ho were seen and followed according to the surveillance protocol in the Yal e Melanoma Unit between January 1988 and December 1994 to determine 1) the time interval between the initial visit and recurrence; 2) the most common method of detecting recurrences; 3) whether the surveillance schedule or th e patient detects more recurrences, i.e., asymptomatic recurrences Versus s ymptomatic recurrences; 4) whether there is any survival difference between asymptomatic and symptomatic recurrences. RESULTS. The 5-year overall survival rates for Stage I, II, and III patient s were 95%, 72%, and 52%, respectively. Of the 78 recurrences, 44 (56%) wer e detected by physician-directed surveillance examinations and 34 (44%) by patients. Most recurrences were found within the first (47%) or second (32% ) year of follow-up. The estimated 6-month hazard rates for death or recurr ence were 0.0044, 0.0088, and 0.0278 for Stage I, II, and III patients, res pectively. The group of asymptomatic patients with recurrence had a surviva l advantage over the symptomatic recurrence group. In addition, patients wi th locoregional recurrence had better survival than those with distant recu rrence. CONCLUSIONS, Although many recurrences arise rapidly and are recognized ear ly by patients, in this study more than half were found by surveillance exa minations before symptoms were manifest. Based on the hazard ratio for recu rrences, the authors recommend the following surveillance schedules in addi tion to the patient education program for detection of recurrences: 1) Stag e I, annually; 2) Stage II, every 6 months for Years 1-2 and annually there after; 3) Stage III, every 3 months for Year 1, every 4 months for Year 2, and every 6 months for Years 3-5; 4) at Year 6 and beyond, all patients sho uld have surveillance annually, due to the risk of late recurrence and/or m etachronous multiple primaries. (C) 1999 American Cancer Society.