December 6, 1995

Utility of Follow-up Tests for Detecting Recurrent Disease in Patients With Malignant Melanomas

Author Affiliations

From the Mayo Clinic and Mayo Foundation, Rochester, Minn (Drs Weiss, Loprinzi, Creagan, and O'Fallon and Mr Novotny), and Duluth (Minn) Community Clinical Oncology Program (Dr Dalton).

JAMA. 1995;274(21):1703-1705. doi:10.1001/jama.1995.03530210057031

Objective.  —To determine the effectiveness of follow-up tests for signaling recurrences in patients with intermediate- and high-risk malignant melanomas treated with curative intention.

Design.  —Retrospective analysis of prospectively collected data.

Setting.  —North Central Cancer Treatment Group.

Patients.  —A total of 261 patients with resected local (≥1.69 mm) and regional nodal malignant melanomas who were enrolled in a single prospective adjuvant trial were studied. All patients were scheduled to be followed up monthly for 2 months, then every 2 months for the first year, every 4 months the second year, every 6 months the next 3 years, and annually thereafter, with each visit consisting of a history, physical examination, complete blood cell count, blood chemistry panel, and a chest x-ray.

Results.  —Of the 145 evaluable patients who developed recurrent melanomas, 99 patients (68%) developed symptoms that signaled the diagnosis of recurrent disease. Physical examination of asymptomatic patients led to the diagnosis of recurrent disease in 37 patients (26%). The other nine patients (6%) with recurrent disease had abnormal chest x-rays. Laboratory results were never a sole indicator of recurrent disease.

Conclusion.  —The majority of recurrences following resection of primary melanomas are discovered by history and/or physical examination despite the frequent use of other follow-up tests. The present data indicate that routine blood analyses and chest x-rays have limited value in the postoperative follow-up of patients with resected intermediate- and high-risk melanomas.(JAMA. 1995;274:1703-1705)