Ultrasound-based follow-up does not increase survival in Stage IB-IIA melanoma

"You have melanoma."  No matter the stage, no matter the situation, these words create chaos and panic for anyone who has ever had to hear them.  BUT!  As I've been posting...

Data for long term survival in thin cutaneous melanoma

SLN biopsy. Delay of 40 days = WHAT???? (Plus some general guidelines) {This one includes links to all things SLNB and CLND...which always comes up upon initial melanoma diagnosis!}

...thin, cutaneous melanoma lesions, caught in early stages, often never progress!  Still....what is one to do for follow-up?  What tests should be done?  When?  A mish mash of follow up options have been recommended over the years...from various sorts of scans, X-rays, nothing, as well as ultrasound.  Now, there's this:

Ultrasound-based follow-up does not increase survival in early-stage melanoma patients: A comparative cohort study. Ribero, Podlipnik, Osella-Abate, et al.  Eur J Cancer. 2017 Sep 7.

Different protocols have been used to follow up melanoma patients in stage I-II. However, there is no consensus on the complementary tests that should be requested or the appropriate intervals between visits. Our aim is to compare an ultrasound-based follow-up with a clinical follow-up.

Analysis of two prospectively collected cohorts of melanoma patients in stage IB-IIA from two tertiary referral centres in Barcelona (clinical-based follow-up [C-FU]) and Turin (ultrasound-based follow-up [US-FU]). Kaplan-Meier curves were used to evaluate distant metastases-free survival (DMFS), disease-free interval (DFI), nodal metastases-free survival (NMFS) and melanoma-specific survival (MSS).

A total of 1149 patients in the American Joint Committee on Cancer stage IB and IIA were included in this study, of which 554 subjects (48%) were enrolled for a C-FU, and 595 patients (52%) received a protocolised US-FU. The median age was 53.8 years with a median follow-up time of 4.14 years. During follow-up, 69 patients (12.5%) in C-FU and 72 patients (12.1%) in US-FU developed disease progression. Median time to relapse for the first metastatic site was 2.11 years for skin metastases, 1.32 for lymph node metastases and 2.84 for distant metastases. The pattern of progression and the total proportion of metastases were not significantly different in the two centres. No difference in DFI, DMFS, NMFS and MSS was found between the two cohorts.  Ultrasound-based follow-up does not increase the survival of melanoma patients in stage IB-IIA.

So....in this study, researchers looked at the status of 1149 Stage Ib and IIa melanoma patients.  554 were provided with "clinic based follow-up" (though what that was exactly is not entirely clear) and 595 were followed via ultrasound.  They were all observed for an average of 4.14 years.  During that time, 12.5% of the clinic followed folks and 12.1% of the ultrasound followed peeps developed disease progression.  Median time for that progression was:  2.11 years for skin mets, 1.32 years for progression in lymph nodes, and 2.84 years for a distant metastasis.  The pattern, proportion, and disease progression was the same in both groups.  In the end, per these researchers, "Ultrasound-based follow-up does not increase the survival of melanoma patients in Stage IB-IIA."

It seems that the bottom line is this:  When you combine a group of Stage I/II melanoma patients, about 12% progress.  That is pretty consistent with the prior reporting, bearing in mind that some "thicker" melanomas would be included here.  And, perhaps most importantly, ultrasound follow-up didn't change that outcome.

Stage I/II melanoma peeps still need to be watched for progression.  Because if you ARE part of that 12% who do progress, you need to deal with that as soon as possible.  But HOW and WHEN to monitor these patients remains elusive.  In the end, I'm betting on a blood draw for DNA markers!!!  Sadly, we aren't there yet.   Sigh. 

For what it's worth.  Hang tough, peeps! - c