Monitoring
Follow-up is indicated for early detection of local recurrence and metastases as well as for second primary cutaneous melanomas. Approximately 13% of patients will develop recurrence of the original primary melanoma, and up to 8% of patients will develop a second primary melanoma.[185][186][187][188]
In the UK, follow-up and monitoring should be offered to:[56]
People who have had stage IA melanoma for 1 year
People who have had stages IB to IV for 5 years.
Follow-up appointments should include:[56]
0 - provide advice at a clinic visit during the first year after treatment has been completed.
IA - consider two clinic appointments, no screening investigations are routinely offered.
IB - year 1: offer two clinical appointments and consider two ultrasounds of the draining nodal basin if the sentinel lymph node biopsy was considered but not done; years 2 and 3: offer one clinical appointment each year, and consider one ultrasound of the draining nodal basin each year if SLNB was considered and not done; years 4 and 5: offer one clinical appointment. Discharge at the end of year 5.
IIA - years 1 and 2: offer two clinic appointments each year, and consider two ultrasounds of the draining nodal basin each year if SLNB was considered and not done; year 3: offer one clinic appointment, consider adding one ultrasound of the draining nodal basin each year if SLNB was considered and not done; years 4 and 5: offer one clinic appointment. Discharge at the end of year 5.
IIB - year 1 and 2: offer four clinic appointments each year, and consider two whole-body and brain contrast-enhanced CT (CE-CT) scans each year; year 3: offer two clinic appointments and consider two whole-body and brain CE-CT scans. Consider two ultrasounds of the draining nodal basin if the sentinel lymph node biopsy was considered but not done; years 4 and 5: offer one clinic appointment each year, and consider one whole-body and brain CE-CT scan each year. Discharge at the end of year 5.
IIC - year 1 and 2: offer four clinic appointments and two whole-body and brain CE-CT scans each year. Consider adding two ultrasounds of the draining nodal basin each year if SLNB was considered but not done; year 3: offer two clinic appointments and two whole-body and brain CE-CT scans. Consider adding two ultrasounds of the draining nodal basin each year if SLNB was considered but not done; year 4 and 5: offer one clinic appointment and one whole-body and brain CE-CT scan each year. Discharge at the end of year 5.
IIIA to IIIC - without adjuvant treatment
Year 1 to 3: offer four clinic appointments and two whole-body and brain CE-CT scans each year. Consider adding two ultrasounds of the draining nodal basin each year if the person has a positive sentinel lymph node. Year 4 and 5: offer two clinic appointments and one whole-body and brain CE-CT scans each year. Discharge at the end of year 5.
IIID and resected IV without adjuvant treatment
Year 1 to 3: offer four clinic appointments and four whole-body and brain CE-CT scans each year.
Year 4 to 5: offer two clinic appointments and two whole-body and brain CE-CT scans each year. Discharge at the end of year 5.
IIIA to IIC, IIID and resected IV with adjuvant treatment
During adjuvant therapy, base follow-up on therapeutic requirements.
US recommendations for follow-up after treatment include:[14]
Melanoma in situ
History and physical examination, with special attention paid to the skin, at least every 12 months.
Stage IA to IIA disease
History and physical examination every 6 to 12 months for 5 years, and then annually as clinically indicated.
Stage IIB to IV melanoma
History and physical examination every 3 to 6 months for 2 years, then every 3 to 12 months for 3 years, then annually as clinically indicated.
Routine laboratory tests and imaging are not required, but specific signs/symptoms suggestive of metastasis should be investigated.
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