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An evidence base for reconsidering current follow-up guidelines for patients with cutaneous melanoma less than 0·5 mm thick at diagnosis

Authors

  • J. Einwachter-Thompson,

    1. Alan Lyell Centre for Dermatology, Greater Glasgow and Clyde University NHS Trust, Glasgow, U.K.
      *Department of Public Health and Health Policy, University of Glasgow, Glasgow G12 8RZ, U.K.
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  • R.M. MacKie

    1. Alan Lyell Centre for Dermatology, Greater Glasgow and Clyde University NHS Trust, Glasgow, U.K.
      *Department of Public Health and Health Policy, University of Glasgow, Glasgow G12 8RZ, U.K.
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  • Conflicts of interest None declared.

Rona MacKie.
E-mail: R.M.Mackie@clinmed.gla.ac.uk

Summary

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.

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