Methods of detection of first recurrence in patients with stage I/II primary cutaneous melanoma after sentinel lymph node biopsy Journal Article
| Authors: | Moore Dalal, K.; Zhou, Q.; Panageas, K. S.; Brady, M. S.; Jaques, D. P.; Coit, D. G. |
| Article Title: | Methods of detection of first recurrence in patients with stage I/II primary cutaneous melanoma after sentinel lymph node biopsy |
| Abstract: | Background: An understanding of the methods of detection of recurrent melanoma after sentinel lymph node biopsy (SLNB) is essential for the coordination of a rational plan of follow-up. Methods: Clinical stage I/II melanoma patients who underwent SLNB from 1991 to 2004 were identified from a prospectively maintained single-institution database. Detection of recurrence by self (awareness of symptoms or abnormal physical findings) or physician (discovered on routine physical or scheduled test) and timing of clinic visit were recorded. Postoperative follow-up included physical exam every 3-4 months for the first year, every 3-6 months for the second year, and every 6-12 months thereafter. Serum lactate dehydrogenase (LDH) and chest X-ray (CXR) were obtained annually. Computed tomography (CT) and positron emission tomography (PET) were performed selectively. Results: Of 1062 patients who underwent SLNB, 203 (19%) experienced 230 initial sites of recurrence; 198 patients were evaluable for follow-up. Median follow-up after first recurrence was 17 months. Symptoms and self-detected physical findings were present in 109 patients (55%); 85 patients (78%) were seen earlier than their scheduled visit. Self-detected physical findings identified in-transit (n = 26; 24%) and nodal (n = 25; 23%) disease. Physician detection occurred in 89 patients (45%), nearly half by a scheduled radiographic test (CXR, 16%; CT, 29%; PET, 1%). The method of detection significantly predicted post-recurrence survival (p < 0.05). Conclusion: More than half of melanoma recurrences are self-detected; these patients have the most favorable post-recurrence survival rates because of the type of recurrence detected. The mode of detection is a significant predictor of post-recurrence survival. This supports an aggressive program of patient education in self-examination after SLNB for melanoma. © 2008 Society of Surgical Oncology. |
| Keywords: | adolescent; adult; human tissue; aged; aged, 80 and over; middle aged; major clinical study; cancer recurrence; cancer staging; positron emission tomography; follow up; neoplasm staging; sentinel lymph node biopsy; tumor localization; melanoma; neoplasm recurrence, local; skin neoplasms; patient education; recurrence; symptom; lactate dehydrogenase; thorax radiography; detection; lactate dehydrogenase blood level; computed tomographic angiography; self examination; primary cutaneous melanoma |
| Journal Title: | Annals of Surgical Oncology |
| Volume: | 15 |
| Issue: | 8 |
| ISSN: | 1068-9265 |
| Publisher: | Springer |
| Date Published: | 2008-08-01 |
| Start Page: | 2206 |
| End Page: | 2214 |
| Language: | English |
| DOI: | 10.1245/s10434-008-9985-z |
| PUBMED: | 18512102 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 7" - "Export Date: 17 November 2011" - "CODEN: ASONF" - "Source: Scopus" |
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