Conflicts of interest None declared.
An evidence base for reconsidering current follow-up guidelines for patients with cutaneous melanoma less than 0·5 mm thick at diagnosis
Article first published online: 28 MAY 2008
© 2008 The Authors. Journal Compilation © 2008 British Association of Dermatologists
British Journal of Dermatology
Volume 159, Issue 2, pages 337–341, August 2008
How to Cite
Einwachter-Thompson, J. and MacKie, R.M. (2008), An evidence base for reconsidering current follow-up guidelines for patients with cutaneous melanoma less than 0·5 mm thick at diagnosis. British Journal of Dermatology, 159: 337–341. doi: 10.1111/j.1365-2133.2008.08641.x
- Issue published online: 17 JUL 2008
- Article first published online: 28 MAY 2008
- Accepted for publication 9 January 2008
- evidence base;
- patient education;
- thin melanoma
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 1992–2001 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.