Surveillance evaluations in patients with stage I, II, III, or resectable IV melanoma who were treated with curative intent: A systematic review

Sudha Rajagopal; Xiaomei Yao; Wadid Abadir; Tara D Baetz; Alexandra Easson; Gregory Knight; Elaine McWhirter; Carolyn Nessim; Cheryl F Rosen; Alexander Sun; Frances C Wright; Teresa M Petrella

doi:10.1016/j.suronc.2024.102077

Surveillance evaluations in patients with stage I, II, III, or resectable IV melanoma who were treated with curative intent: A systematic review

Surg Oncol. 2024 Apr 10:54:102077. doi: 10.1016/j.suronc.2024.102077. Online ahead of print.

Authors

Affiliations

¹ Trillium Health Partners, Credit Valley Hospital, Peel Regional Cancer Centre, 2200 Eglinton Ave West, Mississauga, Ontario L5M 7S4, Canada. Electronic address: Sudha.rajagopal@thp.ca.
² Department of Oncology, Department of Health Research Methods Evidence and Impact, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4L8, Canada; Program in Evidence-Based Care, Ontario Health (Cancer Care Ontario), 711 Concession Street, Hamilton, Ontario, L8V 1C3, Canada. Electronic address: yaoxia@mcmaster.ca.
³ Odette Cancer Centre, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada. Electronic address: wadidabadir@gmail.com.
⁴ Department of Oncology, Cancer Centre of Southeastern Ontario, Kingston Health Sciences Centre, 25 King Street West, Kingston, Ontario, K7L 5P9, Canada. Electronic address: tara.baetz@kingstonhsc.ca.
⁵ Department of Surgery, Marvelle Koffler Breast Centre, Mount Sinai Hospital, 600 University Avenue, Toronto, Ontario, M5G 1X5, Canada. Electronic address: Alexandra.Easson@sinaihealth.ca.
⁶ Department of Oncology, Grand River Regional Cancer Centre, Grand River Hospital, 835 King Street West, Kitchener, Ontario, N2G 1G3, Canada. Electronic address: Gregory.knight@grhosp.on.ca.
⁷ Department of Medical Oncology, Juravinski Cancer Centre, Hamilton Health Sciences, 699 Concession Street, Hamilton, Ontario, L8V 5C2, Canada. Electronic address: emcwhirt@hhsc.ca.
⁸ Department of Surgery, University of Ottawa, The Ottawa Hospital, 501 Smyth Road, Ottawa, Ontario, K1H 8L6, Canada. Electronic address: cnessim@toh.ca.
⁹ Division of Dermatology, Toronto Western Hospital, University Health Network, University of Toronto, 399 Bathurst Street, Toronto, Ontario, M5T 2S8, Canada. Electronic address: crosen019@gmail.com.
¹⁰ Department of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network, 610 University Avenue, Toronto, Ontario, M5G 2M9, Canada. Electronic address: alex.sun@rmp.uhn.ca.
¹¹ Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, Ontario, M4N 3M5, Canada. Electronic address: Frances.wright@sunnybrook.ca.
¹² Odette Cancer Centre, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada. Electronic address: Teresa.petrella@sunnybrook.ca.

PMID: 38657486
DOI: 10.1016/j.suronc.2024.102077

Abstract

Purpose: Appropriate surveillance of patients with melanoma treated with curative intent is vital to improve patient outcomes. A systematic review was conducted to capture locoregional recurrence and metastatic disease, and to evaluate the effectiveness of various surveillance strategies.

Methods: MEDLINE, EMBASE, PubMed, Cochrane Database of Systematic Reviews, and National Cancer Institute Clinical Trials Database were searched. Randomized controlled trials (RCTs) and comparative studies reporting at least one patient-related outcome were included. Exclusion criteria included: published in non-English or recruited >20 % or an uncertain percentage of non-target patients without conducting a subgroup analysis for the target patients. This review was registered at PROSPERO (CRD42021246482).

Results: Among 17,978 publications from the literature search, one RCT and five non-randomized comparative studies were included and comprised 4016 patients. The aggregate evidence certainty was low for the RCT and very low for the comparative studies, as assessed by the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach. For patients with stage IA-IIC melanoma, a reduced follow-up schedule with clinical follow-up strategies alone may be safe and cost-effective. For stage IIC-IIIC patients, at least two serial PET/CT or whole-body CT and brain MRI imaging within a median follow-up of 31.2 months may detect 50 % of recurrences that lead to additional management, such as surgery. PET/CT may have a higher positive predictive value and lower false positive rate compared with CT alone in detecting recurrence in stage I-III patients.

Conclusion: Surveillance protocols should be based on individual risk of recurrence and established best practices when formulating follow-up strategies, as suggested by the studies reviewed. Future high-quality studies are needed to clarify the frequency of imaging follow-up strategies, especially in patients with high-risk stage II melanoma.

Keywords: Melanoma; Surveillance; Systematic review.

Publication types

Review