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There is not currently a clear standard of care for detecting recurrences in patients with melanoma, explains Mario Sznol, MD. Follow-up should be conducted every 3 months for the first 2-3 years, and should include a physical exam and accurate medical history, Jeffrey A. Sosman, MD, states. Laboratory values can be collected at these visits, although it is not generally cost effective. Imaging can be utilized, although this can cause extra anxiety for the patient, notes Sosman.
For patients with high-risk stage IIIb/c disease, scans should be conducted every 6 months for 2-3 years, Sosman suggests. For patients at lower risk for recurrence, imaging can be conducted less frequently. The utilization of CT scans can be individualized based on a patient's risk, Sosman believes.
For patients treated with adjuvant interferon, Sosman will perform a follow up scan at 6 months, since this treatment is generally only provided to patients at high-risk of recurrence. One of the benefits of scanning for patients receiving interferon is that treatment can be stopped if a recurrence is noted, suggests Merrick Ross, MD.
Early imaging allows for the detection of low volume asymptomatic disease, which could benefit more from newly approved therapies, states Omid Hamid, MD. Data has shown that patients with a lower disease burden are more likely to respond to treatment with a PD-1 or CTLA-4 inhibitor, notes Jeffrey S. Weber, MD, PhD. Additionally, for patients with stage IV resected melanoma, scanning every 3 months can help detect isolated relapses that can be resected, Weber notes.
In terms of imaging, the role of MRI in the adjuvant setting for the detection of brain metastases is unclear, notes Hamid. In some institutions, MRI is used annually in the adjuvant setting; however, this varies across the country. In the metastatic space, MRI is generally conducted every 3 months.