Evaluating the yield of adhering to the follow-up guidelines for cutaneous melanoma: a retrospective study of 2048 patients

Abstract

Abstract Background The global rise in the incidence of cutaneous malignant melanoma necessitates an enhanced understanding of the impact on healthcare systems and the effectiveness of current surveillance and diagnostic protocols. The escalating prevalence of eligible patients for follow-up programs poses challenges in timely diagnosis and treatment. This study critically assesses the Danish melanoma follow-up program, focusing on recurrences, de novo melanomas, and the efficacy of detection modalities. Methods This study is a retrospective study based on prospectively collected patient data from Danish Melanoma database (DMD). The study included all patients who were in the clinical follow-up program after treatment of cutaneous malignant melanoma at the Department of Plastic and Breast Surgery, Zealand University Hospital Roskilde from 01/01/2019 to 30/04/2023. Results 2048 patients were included in the study of which 75 patients had recurrences, whereas 38 had de novo malignant melanoma (MM). Among the detected recurrences, 58.9% were detected by imaging modalities, 16% detected by patients’ self-examination, 12.2% detected by independent physicians and 11.5% detected by physicians as a part of follow-up program. Nearly 78.7% of recurrences occurred within the 36-month follow-up. Conclusions The results showed most recurrences were identified within the first three years of follow-up. The introduction of routine PET/CT scans have contributed to the timely identification of these events. The patients themselves find a high number of local cutaneous recurrences. Ultrasound was found to be a very low yield examination and its usefulness as a routine scan can be questioned. The overall findings underscore the importance of refining and optimizing melanoma follow-up programs according to staging to provide early detection and intervention. Level of evidence: Level III,   Risk/Prognostic