Efficacy of ultrasound B-scan compared with physical examination in follow-up of melanoma patients

BACKGROUND. The value of ultrasound B-scan for routine follow-up of melanom a patients still is not generally accepted. Therefore, the authors compared the efficacy of physical examination (PE) with ultrasound B-scan (UTBS) fo r detection of regional rumor recurrence in melanoma patients. The aim of t he current study was to evaluate whether early detection of metastases impr oves relapse-free and overall survival. METHODS. For a period of 4 years, 829 consecutive melanoma patients were fo llowed prospectively. Physical examination of 3011 patients and concomitant UBS of in-transit routes and regional lymph node basins were performed. Su spicious lesions were diagnosed by fine-needle aspiration cytology and path ology. RESULTS. During the study period, 242 (90.6%) of 267 patients with melanoma recurrences were first recognized bp PE or UBS within the routine follow-u p program. The sensitivities of both methods differed significantly (P = 0. 001). Metastases were detected by PE in only 61 of 242 recurrences (25.2%, 95% confidence interval [CI]: 19.9-31.2%), whereas UBS revealed 240 recurre nces (99.2%, 95% CI: 97.3-99.6%). The specificity was 98.4% (95% CI: 97.8-9 8.8%) and 98.3% (95% CI: 97.7-98.7%), respectively. Survival of 103 patient s who presented with a first nodal melanoma recurrence was followed and ana lyzed by multiple Cox regression. Overall survival was affected by the diam eter of the largest metastasis (P = 0.001) and the number of metastatic les ions (P = 0.012). CONCLUSION, The study found that ultrasound B-scan was highly effective in the early detection of regional melanoma metastases compared with physical examination. Earlier detection of such metastases seemed to result in impro ved overall survival. (C) 2001 American Cancer Society.