Improving outcomes for people with skin tumours including melanoma

Improving Outcomes for
People with Skin Tumours
including Melanoma
Follow-up
One observational study found that the interval between primary and
recurrent BCC ranged from 2 to 12 years, with no definite correlation
according to histological type of BCC. The authors concluded that all
patients with excised primary BCC should be followed up for at least
3 years.
Squamous cell carcinoma
The BAD guidelines strongly recommend that self-examination is an
important aspect of continued care and these recommendations are
supported by a review of the current evidence.
5
One systematic review found that the local recurrence rates in patients
with SCC range from 1.3% to 10%, across the different treatment
modalities. Of those SCCs that recur, 58% do so within the first year of
follow-up and 95% do so within the first 5 years of follow-up. The
metastatic rate of primary SCC on sun-exposed sites ranges from 2.3%
to 5.2%. The maximum period of follow-up was five years. Of those
SCCs that metastasise, 69% do so within 1 year of follow-up and 96%
do so within 5 years of follow-up. The review concluded that patients
with SCC should have lifetime follow-up, in order to detect
recurrence, metastasis and new primary skin cancers.
One observational study found the mean duration between excision
and metastasis to be 10.3 months. The rate of metastasis was 2%
overall and the authors suggested that follow-up of patients be
maintained for at least 2 years after treatment.
Melanoma
All patients who have a diagnosis of invasive MM are at risk of
recurrent disease and therefore doctor- or nurse-based follow-up is
worthwhile. Although the risk can be predicted by a variety of
independent risk factors, such as sex, ulceration and site, the single
most commonly used predictor is the Breslow thickness. An inverse
relationship is recognised between Breslow thickness and disease-free
interval. There is, however, increasing evidence that the results from
SNB are a better predictor of survival. SNB is an invasive procedure
with potential morbidity; decisions to undertake SNB should only be
made after careful consideration and only in the specific
circumstances set out in the ‘Initial investigation, diagnosis, staging
and management’ chapter.
108
National Institute for Health and Clinical Excellence