eMedicine Specialties > Oncology > Carcinomas of the Skin

Malignant Melanoma: Follow-up

Author: Winston W Tan, MD, Assistant Professor of Medicine, Mayo Medical School; Consulting Staff, Mayo Group Practices
Contributor Information and Disclosures

Updated: Nov 23, 2009

Follow-up

Further Outpatient Care

  • Follow-up care of a patient with melanoma is based on the stage of the primary. The follow-up examination should be performed with the knowledge that the patient has an increased risk for a second primary and that, of all solitary sites of visceral recurrence, the lungs are the most frequent.
  • Follow-up guidelines from the National Comprehensive Cancer Network are as follows5 :
    • Stage 0 in situ
      • At least annual skin exam for life
      • Educate patient in monthly self skin exam
    • Stage IA
      • History and physical examination (H&P) (with emphasis on nodes and skin) every 3-12 mo for 5 y, then annually as clinically indicated
      • At least annual skin exam for life
      • Educate patient in monthly self skin and lymph node exam
    • Stage IB-IV (patients with no evidence of disease)
      • H&P (with emphasis on nodes and skin) every 3-6 mo for 2 y, then every 3-12 mo for 2 y, then annually as clinically indicated
      • Chest x-ray, LDH, CBC every 6-12 mo (optional)
      • Routine imaging is not recommended for stage IB or IIA disease
      • CT scans to follow up for specific signs and symptoms
      • Consider CT scans to screen Stage IIB and higher for recurrent/metastatic disease
      • At least annual skin exam for life
      • Educate patient in monthly self skin and lymph node exam

Deterrence/Prevention

  • The main focus of melanoma prevention is avoidance of sun exposure. Everyone, especially those individuals at high risk of developing a melanoma, should wear protective clothing, avoid peak sun hours, protect children against UVR exposure, avoid tanning booths, and wear sunscreen with a sun protection factor (SPF) of at least 15. This last recommendation is considered somewhat controversial because no study has shown sunscreen to reduce the incidence of melanoma.23 Moreover, a systematic review found that sunscreen use leads to longer duration of intentional sun exposure, and sunburns tend to be more frequent among sunscreen users.24
  • First-degree relatives of a patient diagnosed with familial melanoma should be encouraged to have annual skin examinations.

Prognosis

  • Prognosis depends on the stage at diagnosis.
    • Patents with stage I disease have a 5-year survival rate greater than 90%.
    • Patients with stage II disease have a 5-year survival rate ranging from 45-77%.
    • Patients with stage III disease have a 5-year survival rate ranging from 27-70%.
    • Patients with metastatic disease have a grim prognosis, with a 5-year survival rate of less than 20%.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Failure to correctly biopsy a suggestive lesion (shave biopsies are contraindicated)
  • Failure to identify need for wide excision
  • Failure to correctly diagnose a melanoma
  • Failure to prescribe a treatment regimen that is considered the standard of care
 
Acknowledgments

Wendy Brick, MD, Consulting Staff, Department of Internal Medicine, Division of Hematology and Oncology, Mecklenburg Medical Group.

Wendy Brick is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Medical Association, and American Society of Hematology.

Coauthor(s): Russell Burgess, MD, Department of Internal Medicine, Division of Hematology/Oncology, East Carolina Internal Medicine



More on Malignant Melanoma

Overview: Malignant Melanoma
Differential Diagnoses & Workup: Malignant Melanoma
Treatment & Medication: Malignant Melanoma
Follow-up: Malignant Melanoma
Multimedia: Malignant Melanoma
References
Further Reading
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References

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Keywords

malignant melanoma, melanoma skin cancer, lentigo maligna melanoma, atypical nevus, atypical nevi, dysplastic nevus, dysplastic nevi, ultraviolet radiation, sentinel lymph node dissection, sentinel node dissection

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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

Medical Editor

Philip Schulman, MD, Chief, Medical Oncology, Department of Medicine, Memorial Sloan-Kettering Cancer Center; Clinical Professor, Department of Medicine, New York University School of Medicine
Philip Schulman, MD is a member of the following medical societies: American Association for Cancer Research, American College of Physicians, American Society of Hematology, and Medical Society of the State of New York
Disclosure: celgene Honoraria Speaking and teaching; Amgen Honoraria Speaking and teaching; genetech/idec Honoraria Speaking and teaching

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Wendy Hu, MD, Consulting Staff, Department of Hematology/Oncology and Bone Marrow Transplantation, Huntington Memorial Medical Center
Wendy Hu, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Blood and Marrow Transplantation, American Society of Hematology, and Physicians for Social Responsibility
Disclosure: Nothing to disclose.

CME Editor

Rajalaxmi McKenna, MD, FACP, Southwest Medical Consultants, SC, Department of Medicine, 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; FibroGen Consulting fee Consulting

 
 
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