Inpatient and outpatient follow-up of grade I malignant melanoma.

Background. In 1995, the French consensus conference on management of patie nts with grade I malignant melanoma recommended clinical examination for pa tient monitoring. To date, only one survey has been conducted to evaluate t hese recommendations and their consequences, providing no means of assessin g follow-up practices. The aim of this study was to assess follow-up practi ces in patients with grade I malignant melanoma followed in an outpatient p rivate practice setting and in a hospital setting with regular appointments . Patients and methods. This retrospective study was conducted in collaborati on with private practice and hospital dermatologists, all members of an ass ociation of continuing medical education. Medical records of 584 patients w ith grade I malignant melanoma who had undergone surgery between January 1, 1991 and December 31, 1995 were reviewed. Three hundred twenty-nine patien ts were followed in an exclusively outpatient setting by their private derm atologist and 265 were followed in a hospital setting. Follow-up data were: age, sex, date of surgical excision of the melanoma, Breslow thickness, da te of each follow-up visit, presence of possible metastases and mode of dia gnosis. Results. Patient features were different in the two groups: mainly greater Breslow thickness and more frequent metastatic course in patients followed in a hospital setting. Among all patients, 65 (11 p. 100) developed metasta ses. Diagnosis of metastasis was made clinically in 95 p. 100 whatever the mode of monitoring considered. The number of patients lost to follow-up was 11p. 100 among those followed in a hospital setting and 42 p. 100 in those followed ina private practice setting. Patients lost to follow-up had a hi gher risk of developing metastasis as their average Breslow thickness was 1 .7 mm. Conclusion. This study shows that patients followed in a hospital setting h ave a more severe prognosis than patients followed in private practice. It confirms that systematic use of complementary tests is of little interest i n detecting metastases since over the period considered, the diagnosis of m etastasis was made clinically in most cases. It also discloses difficulties encountered in exclusively outpatient follow-up as a high number of patien ts were lost to follow-up in this setting. A systematic appointment fixed b y the private dermatologist during the follow-up period appears to be neede d to ensure good quality follow-up. Such an appointment system should help reduce the number of patients lost to follow-up.