Optimizing Follow-up Assessment of Patients with Cutaneous Melanoma

Excerpt

Recently, the use of imaging studies for follow-up assessment of melanoma patients has become a topic of significant controversy. For most of the last 50 years, the prevailing wisdom within the oncology community has been that the majority of melanoma recurrences are detectable by patients or physicians. As a result, the current National Comprehensive Cancer Network (NCCN) guidelines provide wide latitude regarding imaging, allowing physicians to “consider” imaging at intervals ranging from every 3 to 12 months or not at all, depending on the stage and substage of the disease.1 The unspoken reality enabling this highly variable use of imaging studies was that early detection of stage 4 disease offered little value because we had no effective treatments (except perhaps for some patients with resectable metastatic disease). In fact, some might argue that many therapies used for advanced melanoma during the past several decades have been worse than the disease, conferring significant toxicity and little, if any, benefit. In that context, neither physicians nor patients were disadvantaged by waiting for recurrences to become symptomatic or detectable on physical examination. …