Analyzing Controversies in Management and Surveillance of Early-Stage Melanoma
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COMMENTARY
Analyzing Controversies in Management and Surveillance of Early-Stage Melanoma Olga Marushchak
. Ezra Hazan . David A. Kriegel
Received: June 23, 2020 / Accepted: September 4, 2020 Ó The Author(s) 2020
ABSTRACT The incidence of cutaneous melanoma continues to rise dramatically worldwide, presenting a significant burden to the healthcare system. Despite this, there is still controversy in the guidelines regarding follow-up surveillance for patients with thin melanoma. Since there are no randomized clinical trials to support evidence-based guidelines for follow-up surveillance, dermatologic and oncologic organizations have developed their own recommendations based on expert opinion. However, these recommendations differ widely and
are often vague, resulting in considerable variability in the management of early-stage melanoma among clinicians. The benefits of frequent follow-up visits are early detection of recurrent lesions, lower cost of early-stage melanoma compared to that of late-stage melanoma, decreased need for sentinel lymph node biopsy and adjuvant therapies, and the opportunity to educate patients on self-examination and sun protection. However, the high cost of screening and potential increased rates of biopsy, as well as over-imaging and overtreating, pose serious concerns about this approach. While more rigorous research is needed to resolve this controversy, currently clinicians should follow a relatively universal recommendation to tailor the follow-up regimen based on the patient’s relative risk of recurrence and comfort.
Digital Features To view digital features for this article go to https://doi.org/10.6084/m9.figshare.12911654. O. Marushchak Clinical Research, Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA E. Hazan D. A. Kriegel Division of Dermatologic Surgery, Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA O. Marushchak (&) Touro College of Osteopathic Medicine, New York, NY, USA e-mail: [email protected]
Keywords: Early-stage melanoma; Follow-up guidelines; Management controversies
Oncol Ther
Key Summary Points Absence of universal guidelines for followup management in patients with earlystage melanoma may be a source of uncertainty among physicians and inconsistency in patient management. Multiple advantages and disadvantages of different approaches should be addressed to come to a consensus. A patient-centered plan that is based on individual risk factors and comfort is currently recommended.
The incidence of cutaneous melanoma continues to rise dramatically worldwide [1, 2]. According to the National Cancer Institute, there will be over 100,000 new cases of cutaneous melanoma in the United States in 2020, continuing the trend of a constant increase over almost three decades [3]. Cohort studies in Europe demonstrate similar trends and indicate that a further increase in incidence rates is expected in the future [4]. Melanoma presents a considerable public health and a significant co
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