Study in support of PET/CT Surveillance in Stage III melanoma patients

How often to scan/monitor Stage III melanoma patients is a bit unclear and difficult to get insurance to pay for.  This post starts with my own rant about BCBS denying coverage (initially) of an ANNUAL (Finally!  Annual!  After years of CT scans to neck, chest, abdomen and pelvis with MRI's of the brain every 3 months!!!) MRI of my brain (ME!  A melanoma brain met survivor!!) but more importantly includes a message "The Need to Demand Scans in Melaland!" from an amazing lady, the Queen of Melanoma herself, dear Carol Taylor toward the bottom of the post: And then there's me....   

Diagnosed as Stage IIIB in 2003, my scan surveillance was rather random.  There were 2 or 3 PET scans here and there.  But, for the most part I was followed by roughly every 6 month chest X-rays. One such film in 2009 showed a glump of "something" in my bronchus...but since I was an asthmatic we watched and waited, because, as I was emphatically told, "Melanoma never looks like that."  Long story short, a bronchoscopy in 2010 told the tale, "Yes!  Melanoma CAN look like that."  A brain MRI just after showed a brain met as well.  I had NO symptoms.

Now there is this....

PET/CT surveillance detects asymptomatic recurrences in stage IIIB and IIIC melanoma patients: a prospective cohort study. Madu, Timmerman, Wouters, et al.Melanoma Res. 2017 Feb 20.

AJCC stage IIIB and IIIC melanoma patients are at risk for disease relapse or progression. The advent of effective systemic therapies has made curative treatment of progressive disease a possibility. As resection of oligometastatic disease can confer a survival benefit and as immunotherapy is possibly most effective in a low tumor load setting, there is a likely benefit to early detection of progression. The aim of this pilot study was to evaluate a PET/computed tomography (CT) surveillance schedule for resected stage IIIB and IIIC melanoma. From 1-2015, stage IIIB and IIIC melanoma patients at our institution underwent 6-monthly surveillance with PET/CT, together with 3-monthly S100B assessment. When symptoms or elevated S100B were detected, an additional PET/CT was performed. Descriptive statistics were used to evaluate outcomes for this surveillance schedule. Fifty-one patients were followed up, 27 patients developed a recurrence before surveillance imaging, five were detected by an elevated S100B, and one patient was not scanned according to protocol. Eighteen patients were included. Thirty-two scans were acquired. Eleven relapses were suspected on PET/CT. Ten scans were true positive, one case was false positive, and one case was false negative. All recurrences detected by PET/CT were asymptomatic at that time, with a normal range of S100B. The number of scans needed to find one asymptomatic relapse was 3.6. PET/CT surveillance imaging seems to be an effective strategy for detecting asymptomatic recurrence in stage IIIB and IIIC melanoma patients in the first year after complete surgical resection.

Melanoma should be battle enough for anyone.  However, all you melanoma peeps out there are going to have to fight for the care you deserve.  On a positive note, with immunotherapy, targeted therapy and myriad treatment combinations providing real hope of effective options that can render folks stable or NED for years, the plight of Stage III melanoma patients is FINALLY getting some attention from researchers.  Keep pushing peeps.  The Queen and I have been pushing for years. Come on in...the water's...well...wet!!  But, together we can make a difference.  We have to!!! - c