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Utility of Follow-up Tests for Detecting Recurrent Disease in Patients With Malignant Melanomas

Matthias Weiss, MD, PhD; Charles L. Loprinzi, MD; Edward T. Creagan, MD; R. J. Dalton, MD; Paul Novotny, MS; Judith R. O'Fallon, PhD
JAMA. 1995;274(21):1703-1705. doi:10.1001/jama.1995.03530210057031.
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Objective.  —To determine the effectiveness of follow-up tests for signaling recurrences in patients with intermediate- and high-risk malignant melanomas treated with curative intention.

Design.  —Retrospective analysis of prospectively collected data.

Setting.  —North Central Cancer Treatment Group.

Patients.  —A total of 261 patients with resected local (≥1.69 mm) and regional nodal malignant melanomas who were enrolled in a single prospective adjuvant trial were studied. All patients were scheduled to be followed up monthly for 2 months, then every 2 months for the first year, every 4 months the second year, every 6 months the next 3 years, and annually thereafter, with each visit consisting of a history, physical examination, complete blood cell count, blood chemistry panel, and a chest x-ray.

Results.  —Of the 145 evaluable patients who developed recurrent melanomas, 99 patients (68%) developed symptoms that signaled the diagnosis of recurrent disease. Physical examination of asymptomatic patients led to the diagnosis of recurrent disease in 37 patients (26%). The other nine patients (6%) with recurrent disease had abnormal chest x-rays. Laboratory results were never a sole indicator of recurrent disease.

Conclusion.  —The majority of recurrences following resection of primary melanomas are discovered by history and/or physical examination despite the frequent use of other follow-up tests. The present data indicate that routine blood analyses and chest x-rays have limited value in the postoperative follow-up of patients with resected intermediate- and high-risk melanomas.(JAMA. 1995;274:1703-1705)


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