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Patient self-checks are critical for picking up melanoma recurrence

Recurrent melanomas are more likely to found by patient than by routine imaging, study finds

Ingrid Torjesen

Thursday, 09 February 2017

Recurrences of early stage (stage II) melanoma are more often detected by patients and their physicians checking the skin than by routine imaging tests, a study published online by the Journal of the American College of Surgeons has found.

Melanoma has a 95% cure rate if caught and treated early, and studies suggest the recurrence rate for melanoma is as high as 50%.

For this study researchers at Thomas Jefferson University and the University of North Carolina analysed data on 581 patients with stage II melanoma and at least one year of follow-up. Of those, 171 patients with early stage melanoma developed a recurrence (29.4%). Male sex, ulceration, and stage were significant predictors of recurrence.

A total of 40% of recurrences were picked up by patients – either they noticed a suspicious change on their skin or experienced a symptom such as coughing blood or seizures. A further, 30% of recurrent melanomas were identified by scheduled physician examination and 26% by surveillance imaging.

Regional nodes were the most common site of recurrence (30%), followed by lung (27%), and in-transit metastases (18%).

Dr Adam Berger, professor of surgery at Thomas Jefferson University, Philadelphia, said: "We are most concerned about patients who have stage II melanoma. They have more advanced primary melanomas, and on average, between 20 and 45 percent of these patients will die within five years. In the past, we didn't have good therapies for this type of melanoma, but new therapies mean survival continues to improve.

"We wanted to get a break down on how we are discovering recurring melanomas."

He said that the figure of 26% of recurrences being picked up by imaging was "a little higher than what we've seen in the past, which I think reflects the current trend to do more imaging in general. There is a move to use CT scans and other imaging techniques as an important strategy in early recurrence detection."

Very few studies have specifically analyzed recurrence and detection patterns for patients with stage II melanoma. "Our hope is to have some impact on future follow-up guidelines and how we think about screening for recurrent melanoma," Dr. Berger said.

"Patients need to be aware of all of their symptoms and their body. But it's also important for physicians to educate patients as to what to look for and what symptoms are a cause for concern. Patients should examine their skin and the area where lymph nodes would be on a monthly basis. And if they have a symptom that doesn't go away after two or three weeks, it should be brought to a physician's attention, because that is an indicator that the melanoma has come back."

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