An evidence base for reconsidering current follow-up guidelines for patients with cutaneous melanoma less than 05mm thick at diagnosis

Einwachter-Thompson, J. and Mackie, R.M. (2008) An evidence base for reconsidering current follow-up guidelines for patients with cutaneous melanoma less than 05mm thick at diagnosis. British Journal of Dermatology, 159(2), pp. 337-341. (doi: 10.1111/j.1365-2133.2008.08641.x)

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Publisher's URL: http://dx.doi.org/10.1111/j.1365-2133.2008.08641.x

Abstract

Background Despite current guidelines, there is uncertainty about the required duration and frequency of follow-up visits for patients with invasive primary cutaneous melanoma < 0-+5 mm thick. Objectives To review patients with invasive melanoma thinner than 0-+5 mm followed for at least 5 years to provide an evidence base for considering modification of guidelines. Methods A retrospective review of 430 patients diagnosed in the west of Scotland during 1992â€"2001 with melanoma < 0-+5 mm was carried out. Recurrence, deaths from melanoma and second primary melanomas were all identified. Results From 1992 to 2001, 430 melanomas < 0-+5 mm thick at diagnosis were diagnosed out of a total of 3036 primary cutaneous melanomas. To date there have been 593 deaths from melanoma (19%) in the whole group. Five of these deaths were reported in patients with melanomas < 0-+5 mm, but on pathological review two were thicker than 0-+5 mm at diagnosis (1-+5 and > 3 mm), and the remaining three patients all developed thicker second primary melanomas (2-+7, 12-+0 and 19-+0 mm) with a recurrence pattern and timing indicating that these thicker primaries were the cause of death. Fourteen further patients developed a second primary melanoma, and 13 are currently alive and disease free, one dying of other causes. Conclusions Our data indicate that recurrence and subsequent death from melanomas < 0-+5 mm is a very rare event, and that quarterly follow-up for 3 years will yield very few events. Modification of current guideline recommendations are suggested to include a period of patient education concentrating on recognition of second primary tumours followed by rapid access to an expert opinion if required.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Mackie, Professor Rona
Authors: Einwachter-Thompson, J., and Mackie, R.M.
College/School:College of Medical Veterinary and Life Sciences
Journal Name:British Journal of Dermatology
ISSN:00070963

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