Patients more often detect the recurrence of early stage melanoma by self-checks than physicians do by routine imaging tests, research shows.
The study, “Patient Symptoms Are the Most Frequent Indicators of Recurrence in Patients with American Joint Committee on Cancer Stage II Melanoma,” was published on the website of the Journal of the American College of Surgeons.
According to the American Cancer Society, about 87,110 new melanomas will be diagnosed — 52,170 in men and 34,940 in women — in 2017 alone. Melanoma has a 95% cure rate if caught and treated early; however, researchers estimate that nearly 50% of melanoma patients eventually see a recurrence of their cancer.
“We are most concerned about patients who have stage 2 melanoma,” Adam C. Berger, MD, FACS, the study’s co-author and a professor of surgery at Thomas Jefferson University, said in a press release.
“They have more advanced primary melanomas, and on average, between 20 and 45 percent of these patients will die within five years,” he said. “In the past, we didn’t have good therapies for this type of melanoma, but new therapies mean survival continues to improve.”
The study analyzed data from 581 patients with stage 2 melanoma and a minimum of one year of follow-up treatment who had been included in a collaborative database from 1996 to 2015. Among them, 171 patients (29.4%) had cancer recurrence. The most significant predictors of recurrence included male gender, ulceration, and stage of the melanoma.
“We wanted to get a breakdown on how we are discovering recurring melanomas,” Berger said.
The investigators wanted to know if the first step of a recurrence diagnosis was taken by the patient or the physician. The researchers looked at where the first recurrences were diagnosed and how they were detected — by patient reports, by physician exams, or by routine surveillance imaging.
The researchers found that patient reports of self-identified symptoms were the most frequent mode of detection, accounting for 40% of all recurrences. These symptoms included a suspicious change on the skin, coughing blood, or having seizures.
Physician exams accounted for 30 percent of recurrence diagnoses, and surveillance imaging for 26 percent.
One reason that melanoma is a life-threatening disease is because it can spread easily to other organs, like the liver or the lungs. Indeed, most common sites of recurrence included regional nodes (30%), lung metastasis (27%), and in-transit metastases (18%). In-transit metastases are those that form when skin cancer spreads through a lymph vessel and begins to grow more than two centimeters away from the primary tumor but before it reaches the nearest lymph node.
“The fact that imaging picked up 26 percent of patients with recurrence is notable because it is a little higher than what we’ve seen in the past, which I think reflects the current trend to do more imaging in general,” Berger added. “There is a move to use CT scans and other imaging techniques as an important strategy in early recurrence detection.”
This was one of the few studies analyzing recurrence and detection patterns for patients with early stage melanoma, and researchers expect their findings will help clinicians rethink protocols for people diagnosed with melanoma.
The message is that patients and physicians should collaborate, with patient education being key to a successful melanoma treatment. Importantly, people with a past melanoma diagnosis need to be even more aware of symptoms of recurrence.
“Patients need to be aware of all of their symptoms and their body,” Berger said. “But it’s also important for physicians to educate patients as to what to look for and what symptoms are a cause for concern.
“Patients should examine their skin and the area where lymph nodes would be on a monthly basis,” he added. “And if they have a symptom that doesn’t go away after two or three weeks, it should be brought to a physician’s attention, because that is an indicator that the melanoma has come back.”
