Short-term and long-term management of melanoma

Without consensus guidelines for surveillance in patients with resected melanoma, much debate exists on the appropriate short-term and long-term management of melanoma. When discussing surveillance, it is also important to keep in mind the long-term impact of ongoing surveillance in terms of improved survival, patient quality of life, cost effectiveness, and exposure to risks associated with certain surveillance methods. Most studies recommend frequent follow-up visits with dermatologic surveillance to detect potentially curable recurrence, especially resectable locoregional recurrences. Surveillance laboratory tests and chest x-rays (CXR) can have limited value while producing a relatively high falsepositive rate. Lymph node ultrasonography is a valuable imaging modality in patients with equivocal lymphatic nodal basin physical examinations. In patients with early stages of melanoma, the benefit of routine surveillance imaging studies is questionable; however, close surveillance with detailed medical history and physical examination is necessary, with special attention to regional recurrences every 3-12 months, depending on the American Joint Committee on Cancer (AJCC) stage category the patient falls into and the risk of recurrence. In Stage III or greater, more frequent surveillance in the form of more frequent physical examination, laboratory tests based on symptomatology, and cross-sectional imaging may be indicated because of the higher risk of recurrence in this population. CT, MRI, and/or PET/CT are often a component of the overall follow-up for these high-risk patients. Additional studies are needed to better define the role of surveillance in the asymptomatic patient with resected melanoma.