June 2nd, 2010

How Much Follow-up Is Appropriate for Melanoma Survivors?


Once survivors of Stage III melanoma reach a certain time period of recovery, the frequency and intensity of follow-up does not appear to be associated with discovery of resectable first relapses, according to the results of a study published early online in the Journal of Clinical Oncology.[1]

Survivors of Stage III melanoma are at a high risk for recurrence, and this risk varies based on the sub-stage of the disease, with Stage IIIC carrying the highest risk. In spite of this known risk, optimal strategies for follow-up have not been developed in this population.

Researchers from Memorial Sloan-Kettering Cancer Center performed a retrospective analysis of 340 patients who were diagnosed with Stage III melanoma between 1992 and 2004. They evaluated the time and site of recurrence, the method of detection, and the overall survival.

The results indicated that the overall five-year relapse-free survival was 63% for patients with Stage IIIA disease, 32% for Stage IIIB, and 11% for Stage IIIC. In terms of the site of first relapse, 51% were systemic, 28% were local/in-transit, and 21% were regional nodal. Most often, the relapse was detected by the patient: 47% were detected by the patient, 32% were detected by screening radiologic tests, and 21% were detected by the physician.

Currently, the guidelines for follow-up in this patient population are empirical rather than based on data. However, based on the data from this study the researchers concluded that physical examinations and radiologic imaging are unlikely to detect relapse beyond a certain point—specifically, they suggest that:

  • Physical examinations are unlikely to detect recurrence beyond three years in Stage IIIA, two years in Stage IIIB, and one year in Stage IIIC.
  • Radiologic imaging is unlikely to detect recurrence beyond three years for Stages IIIA and IIIB and two years for Stage IIIC.

The researchers stress the fact that their guidelines are not definitive but merely a step in the right direction to determine appropriate follow-up guidelines in this patient population.


[1] Romano E, Scordo M, Dusza SW, et al. Site and timing of first relapse in stage III melanoma patients: Implications for follow-up guidelines. Journal of Clinical Oncology [early online publication]. May 17, 2010.


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