An image of recurrence surveillance

This study examined the effectiveness of routine surveillance imaging in detecting melanoma recurrence and increasing life expectancy.

Melanoma survivors are routinely examined for evidence of cancer recurrence since early detection of recurrence significantly improves survival. Although the importance of recurrence surveillance is undisputed, only a few studies have ever investigated the effectiveness of current surveillance strategies. As a result, there is no consensus regarding the optimal surveillance strategy, and current recommendations are largely based on expert opinion rather than solid evidence.

Usually, melanoma survivors undergo a thorough physical examination at least once a year. Many survivors also undergo routine CT (Computer Tomography) or PET (Positron Emission Tomography) scans. CT and PET are imaging techniques commonly used for recurrence surveillance despite involving exposure to harmful radiation and high costs.

This study analyzed the records of 1600 melanoma patients.  Based on these records and a computer simulation, researchers examined the effect of imaging based surveillance on detecting recurrence and increasing life expectancy.

Results showed that both CT scans and PET scans seem to offer low detection rates beyond those found by physical examination alone. For a patient cured from stage I melanoma being scanned every 12 months, CT and PET scans were estimated to increase recurrence detection by only 3%. For patients cured from stage II melanoma, CT and PET scans were estimated to increase recurrence detection by only 7.9%. For patients cured from stage III melanoma, and considered at a high risk of recurrence, scanning was estimated to increase detection by only 13%.

Both CT and PET do seem to effectively predict the absence of recurrence. However, both imaging techniques are estimated to have a high rate of false positive results (when scans indicate cancer recurrence, although in reality none is found). The effects of recurrence detection by imaging scans on life-expectancy were estimated to be minimal.

This study concluded that the routine use of imaging scans for the surveillance of melanoma survivors does not significantly improve detection rates or increase life expectancy.

Since performing a controlled study with a long enough follow-up period and a large enough number of patients is unrealistic, this study used a computer simulation program to estimate the effects of imaging surveillance.

Consult with your physician regarding the use of imaging surveillance techniques for the detection of melanoma recurrence.