Follow-up of cutaneous melanoma patients: A proposal for standardization

The aim of followup programs for patients diagnosed with melanoma is early detection of local, regional and distant metastasis, as well as early recognition of eventual subsequent primary tumors. Currently, no universally accepted recommendations exist for monitoring patients with cutaneous melanoma. The present recommendations have been developed on the basis of the experience of a group of clinicians affiliated to referral centers dealing with melanoma diagnosis and management in Italy. Clinical evaluation is mandatory at any stage and is intended to be lifelong, with time frequencies of followup visits depending on the specific stage of disease. Sonography of regional lymph nodes has been demonstrated to have the highest accuracy and highest diagnostic validity to detect early regional relapse, and can be considered once per year starting from stage I melanoma. Total body CT scan should be considered in the follow up of patients with higher risk of developing distant metastasis. In stage II and III it should be performed once per year, alternated with abdomen and lymph node ultrasonography. Our aim is to provide a simplified schedule for the routine follow up of melanoma patients. These recommendations are intended as an initial guideline that must be tailored on the individual patient needs.