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Performance of diagnostic tests in an intensive follow-up protocol for patients with American Joint Committee on Cancer (AJCC) stage IIB, IIC, and III localized primary melanoma: A prospective cohort study

  • Sebastian Podlipnik
    Affiliations
    Dermatology Department, Melanoma Unit, Hospital Clinic, and Ititut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain

    Centro de Investigación Biomédica en Red (CIBER) on Rare Disease, Instituto de Salud Carlos III, Barcelona, Spain
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  • Cristina Carrera
    Affiliations
    Dermatology Department, Melanoma Unit, Hospital Clinic, and Ititut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain

    Centro de Investigación Biomédica en Red (CIBER) on Rare Disease, Instituto de Salud Carlos III, Barcelona, Spain
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  • Marcelo Sánchez
    Affiliations
    Radiology Service, Melanoma Unit, Hospital Clinic, and Ititut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
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  • Pedro Arguis
    Affiliations
    Radiology Service, Melanoma Unit, Hospital Clinic, and Ititut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
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  • Maria L. Olondo
    Affiliations
    Radiology Service, Melanoma Unit, Hospital Clinic, and Ititut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
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  • Ramon Vilana
    Affiliations
    Radiology Service, Melanoma Unit, Hospital Clinic, and Ititut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
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  • Ramon Rull
    Affiliations
    Surgery Department, Melanoma Unit, Hospital Clinic, and Ititut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
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  • Sergi Vidal-Sicart
    Affiliations
    Nuclear Medicine Service, Melanoma Unit, Hospital Clinic, and Ititut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
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  • Antonio Vilalta
    Affiliations
    Dermatology Department, Melanoma Unit, Hospital Clinic, and Ititut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
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  • Carles Conill
    Affiliations
    Radiotherapy Oncology, Melanoma Unit, Hospital Clinic, and Ititut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
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  • Josep Malvehy
    Affiliations
    Dermatology Department, Melanoma Unit, Hospital Clinic, and Ititut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain

    Centro de Investigación Biomédica en Red (CIBER) on Rare Disease, Instituto de Salud Carlos III, Barcelona, Spain
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  • Susana Puig
    Correspondence
    Reprint requests: Susana Puig, MD, PhD, Dermatology Department, Melanoma Unit, Hospital Clinic Barcelona, Villarroel 170, 08036, Barcelona, Spain.
    Affiliations
    Dermatology Department, Melanoma Unit, Hospital Clinic, and Ititut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain

    Centro de Investigación Biomédica en Red (CIBER) on Rare Disease, Instituto de Salud Carlos III, Barcelona, Spain
    Search for articles by this author

      Background

      There is no international consensus on optimal follow-up schedules and which supplementary tests should be used after resection of a primary melanoma.

      Objective

      We sought to analyze the performance of the follow-up components and identify procedures that detect melanoma metastasis earlier.

      Methods

      This was a prospective cohort from 290 consecutive patients given a diagnosis of stage IIB, IIC, and III melanoma. Patients were followed up with an intensive protocol based on imaging studies (computed tomography of the chest, abdomen, and pelvis, and brain magnetic resonance imaging), periodic laboratory tests, regular physical examinations, and patient self-examinations.

      Results

      A total of 2382 clinical examinations and 3069 imaging tests were performed. The patients completed 899.8 person-years of follow-up, with a median of 2.5 years. In all, 115 recurrences in 290 patients were recorded, of which computed tomography detected 48.3%; brain magnetic resonance imaging, 7.6%; laboratory test, 2.5%; physician, 23.7%; and patient, 17.8%.

      Limitations

      Patients with stage III melanoma were not systematically classified into subgroups and overall survival was not evaluated.

      Conclusion

      We observed that this intensive monitoring is appropriate for early detection of recurrence in stage IIB, IIC, and III melanoma. Prompt diagnosis of metastasis and the recent development of new therapeutic targets may improve overall survival.

      Key words

      Abbreviations used:

      AJCC (American Joint Committee on Cancer), CT (computed tomography), IQR (interquartile range), MRI (magnetic resonance imaging)
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