Improving outcomes for people with skin tumours including melanoma

Improving Outcomes for
People with Skin Tumours
including Melanoma
Follow-up
Melanoma
Patients with in situ MM do not require follow-up, but should be
given information and instruction as recommended above.
Patients with invasive MM should have a period of formal follow-up,
the frequency and duration of which depends on the risk of metastatic
spread and which should take into account the patient’s psychological
and emotional needs. Detailed recommendations for patients are made
in the BAD guidelines for MM. 55
Patients who have had multiple primaries or those with a family
history of MM require long-term follow-up, sometimes lifelong.
B. Anticipated benefits
5
The anticipated benefits of these recommendations for follow-up
tailored to patients’ risks are that some patients will be reassured by
receiving training in prevention and recognition of new suspicious
lesions. These patients will then be discharged to active selfsurveillance
with the contact details for rapid re-entry into the system,
if they have concerns. This process may also free up more clinic
capacity for the management of patients at high risk of recurrence or
metachronous disease. The problem of the increasing workload of
new patients or patients returning with metachronous lesions,
reflecting the increasing incidence of both of these, may also be
addressed.
For patients at increased risk of recurrent disease, as described above,
a structured follow-up programme may result in earlier detection and
better outcomes. Recurrent disease is often treatable, although more
challenging to treat than primary disease. Access to appropriate MDTs
will ensure that patients receive the expert help they need. Increased
availability of a high level of diagnostic expertise and specialist
imaging will ensure better access to appropriate treatment. The CNS
contribution to the decision-making process about the most
appropriate follow-up for individual patients, based on their
psychosocial as well as their physical needs, can be particularly
valuable.
Patients with NMSC may be entered into clinical trials and studies. It
is important that these patients have adequate follow-up in order to
produce meaningful and useful data. Inadequate follow-up is a
frequent problem in skin cancer research.
55 British Association for Dermatologists (2002) UK guidelines for the management of
cutaneous melanoma. Available from: www.bad.org.uk/healthcare/guidelines
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National Institute for Health and Clinical Excellence