What is the best surveillance strategy after melanoma treatment?

This study reviewed the medical literature about the recurrence (return of the cancer) of melanoma after surgery and current surveillance strategies, in order to maximize the efficacy of surveillance for melanoma patients. 

Melanoma is cancer of the pigment (color) producing cells (melanocytes) of the skin. Treatment usually involves the surgical removal of the lesion. It is recommended that after the surgery patients will remain in surveillance, which includes regular physical examinations and radiological screenings. These follow ups are aimed to detect cancer recurrence or metastases (the spread of cancer in other tissues of the body). However, there are no general guidelines for surveillance, reflecting a lack of consensus on what is the best strategy. This review aims to evaluate which examinations should be included in the follow ups, what intervals and for how long should patients stay in surveillance after treatment in order to ensure a safe follow up strategy preventing over treatment in melanoma patients.  

This article reviewed 72 different studies on recurrent melanoma. Results show that 50% of melanoma recurrences were found in lymph nodes and most of the cases occurred in the first 4 years after diagnosis. Overall, different studies concluded that advanced stages of melanoma should have more intense follow ups and radiology imaging. For early stage melanoma patients, only physical examinations were recommended. One study found that 48% of patients with recurrent melanoma had improved survival rates by detecting early recurrence. However, as time goes by, efficacy of the follow ups was found to be low, especially after 2-3 years. Also, it appears that 62% of patients discover recurrence of melanoma themselves, by regular self-examinations. Overall, the efficacy of high intensity surveillance was not significantly higher than low-intensive surveillance. However, in advanced stages of melanoma, intensive surveillance and radiological imaging showed improved outcomes.  

This study concluded that each patient should receive follow ups according to their specific disease stage and overall health. In addition, all surveillance strategies should include teaching the patient how to perform self-examinations and prevent recurrence (such as applying sun screen and avoiding sun exposure).  

Consult with your doctor about the best approach for surveillance in your situation.