Long-term Follow-up for Melanoma Patients

Cumulative findings support the current National Comprehensive Cancer Network guidelines for surveillance in early-stage melanoma (stages IA–IIA), which recommend lifelong dermatologic surveillance with regular comprehensive skin exams, adding imaging studies only if there is clinical suspicion of recurrence.1 Regular clinical examination offers the highest diagnostic yield in detecting melanoma recurrences, with additional diagnostic benefit seen when imaging is used for patients in whom clinical evaluation or symptomatic presentation suggests the presence of distant disease. However, for patients with locally or regionally advanced melanoma (stages IIB–IIIC), there is a paucity of data to support the use of rigorous, routine surveillance imaging studies following appropriate staging and surgical treatment of their disease. Contemporary guidelines recommend, on the basis of low-level evidence (category 2B), that clinicians consider the addition of CT and/or PET/CT every 3 to 12 months for these patients.1 However, current data indicate that such a regimen would result in an exceedingly large number of studies performed to detect a limited number of surgically treatable recurrences and would have little impact on patient survival. Although there likely is a subset of patients with high risk melanoma in whom routine oncologic imaging surveillance has the potential to offer survival benefit, a more judicious approach to the use of imaging studies may be equally effective with little detrimental impact on survival. Such considerations are of increasing interest in the modern era of rising health care costs and impending limitations on resource utilization.