Abstract
Background
Follow-up practices after diagnosis and treatment of primary cutaneous melanoma vary considerably. We aimed to determine factors associated with recommendations for follow-up setting, frequency, skin surveillance, and concordance with clinical guidelines.
Methods
The population-based Melanoma Patterns of Care study documented clinicians’ recommendations for follow-up for 2148 patients diagnosed with primary cutaneous melanoma over a 12-month period (2006/2007) in New South Wales, Australia. Multivariate log binomial regression models adjusted for patient and lesion characteristics were used to examine factors associated with follow-up practices.
Results
Of 2158 melanomas, Breslow thickness was < 1 mm for 57% and ≥ 1 mm for 30%, while in situ melanomas accounted for 13%. Follow-up was recommended for 2063 patients (96%). On multivariate analysis, factors associated with a recommendation for follow-up at a specialist center were Breslow thickness ≥ 1 mm [prevalence ratio (PR) 1.05, 95% confidence interval (CI) 1.01–1.09] and initial treatment at a specialist center (PR 1.12, 95% CI 1.08–1.16). Longer follow-up intervals of > 3 months were more likely to be recommended for females, less likely for people living in rural compared with urban areas, and less likely for thicker (≥ 1 mm) melanomas compared with in situ melanomas. Skin self-examination was encouraged in 84% of consultations and was less likely to be recommended for patients ≥ 70 years (PR 0.88, 95% CI 0.84–0.93) and for those with thicker (≥ 1 mm) melanomas (PR 0.92, 95% CI 0.86–0.99). Only 1% of patients were referred for psychological care.
Conclusions
Follow-up recommendations were generally consistent with Australian national guidelines for management of melanoma, however some variations could be targeted to improve patient outcomes.
Similar content being viewed by others
References
Australian Institute of Health and Welfare. Australian Cancer Incidence and Mortality (ACIM) books: Melanoma of the skin. Canberra: AIHW. www.aihw.gov.au/acim–books [Accessed February 2017] 2017.
Gershenwald JE, Scolyer RA, Hess KR, et al. Melanoma Staging: Evidence-Based Changes in the American Joint Committee on Cancer (AJCC) Eighth Edition Cancer Staging Manual. CA: A Cancer Journal 2017; In press.
Turner RM, Bell KJ, Morton RL, et al. Optimizing the frequency of follow-up visits for patients treated for localized primary cutaneous melanoma. J Clin Oncol. 2011;29:4641–6.
Bradford PT, Freedman DM, Goldstein AM, Tucker MA. Increased risk of second primary cancers after a diagnosis of melanoma. Arch Dermatol. 2010;146:265–72.
Titus-Ernstoff L, Perry AE, Spencer SK, et al. Multiple primary melanoma: two-year results from a population-based study. Arch Dermatol. 2006;142:433-8.
Youlden DR, Youl PH, Soyer HP, Aitken JF, Baade PD. Distribution of subsequent primary invasive melanomas following a first primary invasive or in situ melanoma Queensland, Australia, 1982–2010. JAMA Dermatol. 2014;150:526–34.
Francken AB, Bastiaannet E, Hoekstra HJ. Follow-up in patients with localised primary cutaneous melanoma. Lancet Oncol. 2005;6:608–21.
Dicker TJ, Kavanagh GM, Herd RM, et al. A rational approach to melanoma follow-up in patients with primary cutaneous melanoma. Scottish Melanoma Group. Br J Dermatol. 1999;140:249–54.
Maurichi A, Miceli R, Camerini T, et al. Prediction of survival in patients with thin melanoma: results from a multi-institution study. J Clin Oncol. 2014;32:2479–85.
Francken AB, Shaw HM, Accortt NA, Soong SJ, Hoekstra HJ, Thompson JF. Detection of first relapse in cutaneous melanoma patients: implications for the formulation of evidence-based follow-up guidelines. Ann Surg Oncol. 2007;14:1924–33.
McPherson M, Elwood M, English DR, Baade PD, Youl PH, Aitken JF. Presentation and detection of invasive melanoma in a high-risk population. J Am Acad Dermatol .2006;54:783-92.
Dummer R, Hauschild A, Guggenheim M, Keilholz U, Pentheroudakis G. Cutaneous melanoma: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol 2012;23(7):86–91.
Cromwell KD, Ross MI, Xing Y, et al. Variability in melanoma post-treatment surveillance practices by country and physician specialty: a systematic review. Melanoma Res. 2012;22:376–85.
World Health Organisation. international classification of diseases for oncology (ICD-O-3). Geneva: World Health Organisation; 2000.
Pink B. SEIFA Technical Report 2011. Australian Bureau of Statistics 2013;2033.0.55.001.
McNutt LA, Wu C, Xue X, Hafner JP. Estimating the relative risk in cohort studies and clinical trials of common outcomes. Am J Epidemiol. 2003;157:940-3.
Petersen MR, Deddens JA. A comparison of two methods for estimating prevalence ratios. BMC Med Res Methodol. 2008;8:9.
von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. PLoS Med. 2007;4:e296.
Australian Cancer Network. Clinical Practice Guidelines. The management of cutaneous melanoma. National Health and Medical Research Council (NHMRC) 1999:1–81.
Bilimoria KY, Raval MV, Bentrem DJ, Wayne JD, Balch CM, Ko CY. National assessment of melanoma care using formally developed quality indicators. J Clin Oncol. 2009;27:5445–51.
Geller AC, Zhang Z, Sober AJ, et al. The first 15 years of the American Academy of Dermatology skin cancer screening programs: 1985–1999. J Am Acad Dermatol. 2003;48:34–41.
Hanrahan PF, Hersey P, D’Este CA. Factors involved in presentation of older people with thick melanoma. Med J Aust. 1998;169:410-4.
McCarthy WH, Shaw HM, Thompson JF, Milton GW. Time and frequency of recurrence of cutaneous stage I malignant melanoma with guidelines for follow-up study. Surg Gynecol Obstet. 1988;166:497–502.
Scally CP, Wong SL. Intensity of follow-up after melanoma surgery. Ann Surg Oncol. 2014;21:752–7.
Moloney FJ, Guitera P, Coates E, et al. Detection of primary melanoma in individuals at extreme high risk: a prospective 5-year follow-up study. JAMA Dermatol. 2014;150:819–27.
Watts CG, Dieng M, Morton RL, Mann GJ, Menzies SW, Cust AE. Clinical practice guidelines for identification, screening and follow-up of individuals at high risk of primary cutaneous melanoma: a systematic review. Br J Dermatol .2015;172:33–47.
Damude S, Hoekstra-Weebers JE, Francken AB, Ter Meulen S, Bastiaannet E, Hoekstra HJ. The MELFO-study: prospective, randomized, clinical trial for the evaluation of a stage-adjusted reduced follow-up schedule in cutaneous melanoma patients-results after 1 year. Ann Surg Oncol. 2016;23:2762–71.
Australian Cancer Network. Clinical practice guidelines for the management of melanoma in Australia and New Zealand: evidence-based best practice guidelines. National Health and Medical Research Council (Australia), Commonwealth of Australia 2008; Canberra, ACT.:1-225.
Coit DG, Thompson JA, Andtbacka R, et al. Melanoma, Version 4.2014. J Natl Comprehensive Cancer Netw. 2014;12:621–9
National Comprehensive Cancer Network (NCCN). NCCN clinical practice guidelines in oncology. Melanoma United States. 2009;Version 2.0 2009.
Rychetnik L, Morton RL, McCaffery K, Thompson JF, Menzies SW, Irwig L. Shared care in the follow-up of early-stage melanoma: a qualitative study of Australian melanoma clinicians’ perspectives and models of care. BMC Health Serv Res. 2012;12:468.
Mitchell J, Callaghan P, Street J, Neuhaus S, Bessen T. The experience of melanoma follow-up care: an online survey of patients in australia. J Skin Cancer. 2014;2014:429149.
Morton RL, Rychetnik L, McCaffery K, Thompson JF, Irwig L. Patients’ perspectives of long-term follow-up for localised cutaneous melanoma. Eur J Surg Oncol. 2013;39:297–303.
Rychetnik L, McCaffery K, Morton RL, Thompson JF, Menzies SW, Irwig L. Follow-up of early stage melanoma: specialist clinician perspectives on the functions of follow-up and implications for extending follow-up intervals. J Surg Oncol. 2013;107:463–8.
Varey AHR, Madronio CM, Cust AE, et al. Poor adherence to national clinical management guidelines: a population-based, cross-sectional study of the surgical management of melanoma in New South Wales, Australia. Ann Surg Oncol. 2017;24:2080–8.
Dieng M, Butow PN, Costa DSJ, et al. Psychoeducational intervention to reduce fear of cancer recurrence in people at high risk of developing another primary melanoma: results of a randomized controlled trial. J Clin Oncol. 2016;34:4405–14.
Acknowledgements
We are indebted to Prof. Bruce K Armstrong, DPhil, FRACP, FAFPHM, FAA for his guidance with the analysis of data from the Melanoma Patterns of Care study. This study was funded by the Cancer Institute NSW, with additional financial support provided by Melanoma Institute Australia and the NSW Melanoma Network. Anne E. Cust was supported by an NHMRC Career Development Fellowship (no. 1063593) and a Cancer Institute NSW Fellowship (no. 15/CDF/1- 14). John F. Thompson was supported by the Melanoma Foundation of the University of Sydney. Rachael L. Morton was supported by an Australian National Health and Medical Research (NHMRC) Fellowship (no. 1054216)..
Disclosure
None.
Author information
Authors and Affiliations
Corresponding author
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Read, R.L., Madronio, C.M., Cust, A.E. et al. Follow-Up Recommendations after Diagnosis of Primary Cutaneous Melanoma: A Population-Based Study in New South Wales, Australia. Ann Surg Oncol 25, 617–625 (2018). https://doi.org/10.1245/s10434-017-6319-z
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1245/s10434-017-6319-z