In this section, you will find information about follow-up for each stage of melanoma. 

 

Stage 0 

Stage I

Stage II

Stage III

Stage IV

 

Stage 0: Recommendation for Follow-up 

After treatment, all patients with Stage 0 melanoma should receive a physical examination, including a skin examination, on the following schedule: 

Type of Follow-up	Description of Follow-up
Skin Examination   Physical Examination	Years 1, 2: every 6-12 months After Year 2: annually   Years 1, 2: every 6-12 months    Years 3, 4, 5: annually

 

All patients with Stage 0 melanoma should have a skin examination at least once a year for the rest of their life. The frequency of examinations after 2 years depends on the perceived level of risk for new primary melanomas and for the recurrence of the previous tumor.

 

Good news! When melanoma is found and treated early, the chances for long-term, disease-free survival are excellent. With treatment, patients with Melanoma in situ have a 5- and 10-year overall survival rate of 99-100%. (1)  Keep in mind that these statistics shown for survival are averages; everyone's cancer and survival rate is based on many factors and determined on an individual basis.

 

For what to do if melanoma recurs click here.

 

 Stage I: Recommendation for Follow-up

 After treatment, all patients with Stage I melanoma should receive a physical examination, including a skin examination, on the following schedule: 

Type of Follow-up	Description of Follow-up
Skin Examination   Physical Examination	Years 1, 2: every 6-12 months After Year 2: annually   Years 1, 2: every 6 -12 months Years 3, 4, 5: annually

 

All patients with Stage I Melanoma should have a physical examination including a skin examination, every 6-12 months for the first 2 years, and at least annually for years 3-5. The frequency of phsyical examinations after 2 years depends on the perceived level of risk for new primary melanomas and for recurrence of the previous tumor. 

 

All patients with Stage I Melanoma should have a skin examination at least once a year for the rest of their life.

 

Good News! With the right surgery, patients with Stage I melanoma are considered at low risk for local recurrence or for regional and distant metastases. Therefore early detection of melanoma through skin self-examination and physical examination continues to be of utmost importance. 

 

Large scale studies have shown  the following probabilities of disease-free survival. Keep in mind that these statistics shown for survival are averages; everyone's cancer an survival rate is based on many factors and determined on an individual basis. 

Survival

 

5 years after treatment (1)	10 years after treatment (1)
Stage IA    97%	Stage IA:    95%
Stage IB    92%	Stage IB:    86%

 

 Stage II: Recommendation for Follow-up

 After treatment, all patients with Stage II melanoma should receive a physical examination, including a skin examination, on the following schedule: 

 

Type of Follow-up	Description of Follow-up
Physical Examination (including skin examination)	Year 1: every 3 months Year 2: every 4 months Years 3-5: at least every 6 months
Testing LDH (Serum Lactate Dehydrogenase)	For patients with Stage II B or IIC melanoma

 

 

All patients with Stage II melanoma should have a physical examination, including a skin examination, every 3 months for the first year, every 4 months for the second year, and at least every 6 months for years 3-5. The frequency of physical examinations after  years depends on the perceived level of risk for new primary melanomas and for the recurrence of the previous tumor. 

 

All patients with Stage II melanoma should have a skin examination at least once a year for the rest of their life.  

 

As part of their examinations, patients with Stage IIB or IIC should also be tested for LDH (serum lactate dehydrogena). 

 

With treatment, Stage II melanoma is considered intermediate- to high-risk for local recurrence or distant metastasis. Therefore, early detection of melanoma through skin self-examination and medical examination continues to be of the utmost importance. 

 

Large-scale studies have shown the following probabilities of disease-free survival 5 years after treatment: Keep in mind that these statistics shown for survival are averages; everyone's cancer and survival rate is based on many factors and determined on an individual basis. 

Survival

 

5 years after treatment (1)	10 years after treatment (1)
Stage IIA:   81%	Stage IIA:  67%
Stage IIB:   70%	Stage IIB:   57%
Stage IIC:  53%	Stage IIC:   40%

 

For more on what to do if melanoma recurs click here.

 

 Stage III: Recommendation for Follow-up

After treatment, patients with Stage III melanoma should receive a physical examination, including a skin examination, and regular chest x-rays, serum LDH testing, and CT scans of the trunk, pelvis, and head. The following schedule is recommended: 

 

Type of Follow-up	Description of Follow-up
Physical Examination (including skin examiantion, chest x-rays, CT scans of trunk, pelvis, head	Year 1: every 3 months Year 2: every 4 months Year 3-5: at least every 6 months Annually after 5 years
Testing for Serum Lactate Dehydrogenase (LDH)	For all patients at same time as physical exam

 

 

With treatment, Stage III melanoma is considered intermediate- to high-risk for local recurrence or distant metastasis. 

 

Therefore early detection of melanoma through skin self-examination and medical examination continues to be of the utmost importance. 

 

Large scale studies have shown the following probabilities of disease-free survival: 

Survival

5 years after treatment (1)	10 years after treatment (1)
Stage IIIA    78%	Stage IIIA:    68%
Stage IIIB    59%	Stage IIIB:    43%
Stage IIIC    40%	Stage IIIC:    24%

                    

Stage IV: Recommendations for Follow-up

Stage IV melanoma represents an active but varied stage of disease. Therefore, follow-up for patients may be required every 3 months, monthly, or even weekly. The follow-up schedule should be arranged in accordance with the level of symptoms and anticipated effects of the disease.

 

Tumor Marker Tests are under investigation as follow-up for Stage IV melanoma. 

Type of Follow-up	Description of Follow-up
Tumor Marker Tests	Tumor markers are substances produced by tumor cells, or by the body in response to tumor cells. As tumor cells multiply, tumor markers increase, and enter the bloodstream.   Tumor markers levels in the blood help to evaluate whether treatment is working and/or if disease is progressing.   Higher levels of tumor marker in the blood usually mean the cancer is more advanced

 

Blood tests for the following tumor markers are currently under investigation for Stage IV melanoma:

 

• S-100 B and melanoma-inhibiting activity (MIA) are proteins secreted by malignant melanoma cells. They are detected in the blood by immunoassay, a technique of identifying a substance based on its ability to act as an antigen.
• Reverse transcriptase polymerase chain reaction (RT-PCR) assay is a molecular biologic technique commonly used to detect HIV. New RT-PCR assays can detect tyronsinase, an enzyme associated with the production of melanin, and a possible tumor marker for melanoma

 

Stage IV melanoma is considered at high risk for local recurrence or distant metastasis. Large scale studies have shown the following probabilities of disease free survival for 1, 2, and 5 years respectively. (1)  Keep in mind that the statistics shown for survival are averages; everyone's cancer and survival rate is based on many factors and determined on an individual basis.

Survival

 

Metastasis Location	1 Year	2 Year	5 Year
Distant skin, soft tissue, and/or lymph nodes	54%	36%	19%
Lung	53%	31%	15%
Visceral	35%	18%	9%

 

 

The following factors may provide a relatively more favorable prognosis and help guide decisions about whether to pursue therapy:

 

• A limited number of sites of disease
• The disease is limited to soft tissues and lymph nodes rather than bone and vital organs
• Stage IV disease does not develop until more than 1 year after treatment of earlier-stage disease
• The occurrence of an observable and favorable response to treatment

 Additional favorable patient factors for stage IV include:

 

• A normal appetite
• Absence of nausea, vomiting, or fever;
• The ability to conduct daily activities unimpaired
• Being female.

 

Reference:

1. American Cancer society.