Routine imaging to detect recurrences in high-risk melanoma patients.

Abstract

8576 Background: Strategies for followup surveillance in melanoma patients are controversial and in general emphasize clinical exam as the primary screening method. We aim to determine the modalities that detected disease recurrence in high-risk melanoma patients being followed in adjuvant clinical trials. Methods: A retrospective analysis was performed on a prospective database containing 4 adjuvant melanoma immunotherapy trials from 1998-2009, the results of which have been published in part. Patients with ulcerated or ≥1.5mm primary melanomas or completely resected locoregional disease or distant metastases were eligible within 6 months of surgery. They were screened with physical exam, lab tests, brain MRI, and CT scan of chest, abdomen and pelvis. Depending on the protocol, they were followed with physical exam, imaging and lab tests every 3-6 months in the first year and every 6-12 months in subsequent years. We here evaluate the method of relapse detection based on the site of relapse. Results: Of 474 patients enrolled, 459 were evaluable, of which 109 (24%) had resected stage II disease, 327 (71%) had stage III and 23 (5%) had stage IV. 221 patients (48%) developed recurrent disease. Median time to relapse from enrollment date was 8 months. Recurrences were detected by the patient, physician exam or routine imaging in 25% (56/221), 13% (28/221) and 58% (128/221), respectively. 1% (3/221) was detected by abnormal blood tests. Site of relapse was locoregional in 38% and systemic in 62%. In those with locoregional relapse, 30% were detected by routine imaging, 43% by the patient, 23% by physician exam and 5% by either patient or physician exam. In those with systemic relapse, 75% were detected by routine imaging, 15% by the patient, 7% by physician exam and 2% by abnormal lab values. Conclusions: Routine imaging identified 58% of recurrences not found by the patient or physician exam in these high-risk melanoma patients. The addition of routine imaging found additional disease in 30% of those with locoregional relapses and 75% of those with systemic relapses not suspected by the patient or physician. This study could not determine whether aggressive radiologic followup detecting early recurrence translated into improved survival for these patients.