eMedicine Specialties > Oncology > Carcinomas of the Skin

Lentigo Maligna Melanoma: Follow-up

Author: Winston W Tan, MD, Assistant Professor of Medicine, Mayo Medical School; Consulting Staff, Mayo Group Practices
Coauthor(s): Antony J Charles, MD, Fellow, Department of Hematology and Oncology, Mayo Clinic, St Luke's Hospital; Broc L Pratt, MD, Consulting Staff, Metrolina Plastic Surgery, Charlotte, North Carolina; B Todd Heniford, MD, Assistant Clinical Professor, Department of General Surgery, University of North Carolina; Chief, Division of Minimal Access Surgery, Carolinas Medical Center
Contributor Information and Disclosures

Updated: Mar 4, 2009

Follow-up

Further Outpatient Care

  • Follow-up consists of examination of the skin, the primary site, and the regional nodal basin.
  • The National Cancer Institute recommends follow-up every 6 months for the first 2 years after surgical therapy in patients without atypical moles and without a family history of melanoma. If the patient is disease-free at 2 years, conduct yearly follow-up visits.
  • For patients with atypical moles or a positive family history, follow up every 3-6 months.
  • Base the decision to extend the interval after 2 years on the stability and characteristics of the atypical moles.

Deterrence/Prevention

Avoidance of sun exposure and use of sunscreen is highly recommended.

Prognosis

  • The overall prognosis is good for patients with localized melanoma and no nodal or distant metastases. An overall 5-year survival rate of 79% has been reported for patients with stage I or stage II lesions.
  • In patients with regional nodal disease (ie, stage III), the 3 dominant prognostic variables are the number of nodal metastases, the patient's age, and ulceration in the primary tumor.
    • Numerous studies have shown that the number of nodes with metastases has significant prognostic value in patients with stage III disease. Patients with 1 positive node fared the best; 40% remained alive at 10 years. Those with 2-4 positive nodes had an intermediate 10-year survival rate of 26%. Patients with 5 or more positive nodes had the lowest 10-year survival rate, at 15%.
    • In both men and women with stage III melanoma, patients older than 50 years tend to do worse. In studies evaluating tumor ulceration as a prognostic factor in lentigo maligna melanoma, the 3-year survival rate for patients with an ulcerated primary tumor was 20%, compared with 35% for those with nonulcerated primary lesions.
  • Patients with stage IV melanoma generally have a poor prognosis. From the time the metastasis is diagnosed, the median survival is 6-7.5 months, with a 5-year survival rate of approximately 6%.

Patient Education

  • Education plays an integral role in the follow-up care of patients with melanoma.
  • Instruct patients on self-examination for new and locoregional recurrences. Teach them to recognize the classic characteristics of cutaneous melanoma in friends and family. In addition, during every follow-up visit, counsel patients to avoid excess sun exposure, to use sunblock liberally, and to wear protective clothing.
  • For excellent patient education resources, visit eMedicine's Cancer and Tumors Center. Also, see eMedicine's patient education articles Skin Cancer and Skin Biopsy.

Miscellaneous

Medicolegal Pitfalls

  • Failure to diagnose, which is often the case with skin lesions that were initially thought to be benign without a biopsy
  • Failure to provide adequate follow-up care
    • Melanoma should be managed by a multidisciplinary team.
    • The team should include a dermatologist, surgeon, medical oncologist, and other allied health workers.
 


More on Lentigo Maligna Melanoma

Overview: Lentigo Maligna Melanoma
Differential Diagnoses & Workup: Lentigo Maligna Melanoma
Treatment & Medication: Lentigo Maligna Melanoma
Follow-up: Lentigo Maligna Melanoma
References
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References

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Further Reading

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Keywords

skin cancer, skin cancer diagnosis, skin cancer treatment, skin cancer symptoms, malignant melanoma, skin malignancy, cutaneous malignancy, cutaneous melanoma, skin melanoma, cutaneous neoplasm, skin neoplasm, Hutchinson's melanotic freckle, Hutchinson melanotic freckle, freckle cancer, lentigo maligna, LM, lentigo maligna melanoma, LMM, melanoma in-situ, UV light exposure, ultraviolet light exposure, UV radiation exposure, ultraviolet radiation exposure, melanocytic nevus, melanocytic nevi

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Contributor Information and Disclosures

Author

Winston W Tan, MD, Assistant Professor of Medicine, Mayo Medical School; Consulting Staff, Mayo Group Practices
Winston W Tan, MD is a member of the following medical societies: American College of Physicians, American Society of Clinical Oncology, American Society of Hematology, Philippine Medical Association, and Texas Medical Association
Disclosure: Roche Grant/research funds Other; Sanofi Aventis Grant/research funds Other; Genentech Grant/research funds Other; Bristol Myers Squibb Grant/research funds Other

Coauthor(s)

Antony J Charles, MD, Fellow, Department of Hematology and Oncology, Mayo Clinic, St Luke's Hospital
Antony J Charles, MD is a member of the following medical societies: American Society of Clinical Oncology
Disclosure: Nothing to disclose.

Broc L Pratt, MD, Consulting Staff, Metrolina Plastic Surgery, Charlotte, North Carolina
Disclosure: Nothing to disclose.

B Todd Heniford, MD, Assistant Clinical Professor, Department of General Surgery, University of North Carolina; Chief, Division of Minimal Access Surgery, Carolinas Medical Center
B Todd Heniford, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Surgeons, American Medical Association, American Society for Gastrointestinal Endoscopy, Association for Academic Surgery, and Society for Surgery of the Alimentary Tract
Disclosure: Nothing to disclose.

Medical Editor

Michael Perry, MD, MS, MACP, Nellie B Smith Chair of Oncology Emeritus, Professor, Department of Internal Medicine, Division of Hematology and Oncology, University of Missouri /Ellis Fischel Cancer Center
Michael Perry, MD, MS, MACP is a member of the following medical societies: Alpha Omega Alpha, American Association for Cancer Research, American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Medical Association, American Society of Clinical Oncology, American Society of Hematology, International Association for the Study of Lung Cancer, and Missouri State Medical Association
Disclosure: Bionumerik Consulting fee Consulting; Proactya Consulting fee Consulting; GSK Consulting fee Consulting; NovoNordisk Consulting fee Consulting; Amgen Honoraria Speaking and teaching; GSK Consulting fee Speaking and teaching

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

CME Editor

Rajalaxmi McKenna, MD, FACP, Consulting Staff, Department of Medicine, Southwest Medical Consultants, SC, Good Samaritan Hospital, Advocate Health Systems
Rajalaxmi McKenna, MD, FACP is a member of the following medical societies: American Society of Clinical Oncology, American Society of Hematology, and International Society on Thrombosis and Haemostasis
Disclosure: Nothing to disclose.

Chief Editor

Jules E Harris, MD, Clinical Professor of Medicine, Division of Hematology/Medical Oncology, Department of Internal Medicine, University of Arizona College of Medicine at Tucson; Consulting Staff, Arizona Cancer Center
Jules E Harris, MD is a member of the following medical societies: American Association for Cancer Research, American Association for the Advancement of Science, American Association of Immunologists, American Society of Hematology, and Central Society for Clinical Research
Disclosure: GlobeImmune Salary Consulting; Amplimed Consulting fee Consulting

 
 
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