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Follow-Up for Stage IV Melanoma

Stage IV melanoma represents melanoma that cannot be surgically removed or those that have been treated but have a very high risk of recurrance. Depending upon the circumstances, 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, anticipated effects of the disease and the treatments.

 

Type of Follow-up

Description of Follow-up

Skin Examination

 

 

Physical Examination

 

 

 

Imaging Tests

 

 

Brain MRI

Annually by healthcare provider

Monthly self-examination

 

Years 1-2: every 3-6 months

Years 3-5: every 3-12 months

After Years 5: annually as needed

Monthly self-examination of lymph nodes

 

Possibly every 3-12 months to check for recurrence

 

Possibly annually

 

Stage IV melanoma that has been completely removed (NED = no evidence of disease) is usually followed closely in the clinic with physical exams, blood work, and scans on an every 3-6 month basis for at least the first two years, and then spaced out over time. These patients are followed at least annually after year 5. There is no standard systemic treatment after surgery or radiation. There are drugs and clinical trials available.

 

Imaging tests are recommended if specific signs of cancer appear.  You may also receive imaging tests every 3-12 months to check for cancer recurrence that isn't causing symptoms. Possible tests for screening include a chest x-ray, CT scan, and a PET/CT scan; and a brain MRI every year. These tests may be done for up to 5 years after treatment has ended.  Imaging tests are not recommended after 5 years if there has been no recurrence and you don't have symptoms.

 

Stage IV melanoma is not considered curable and all treatments are with the goal of controlling the melanoma, it possible. 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

 62% 43% 28%
Lung 53% 31%

15%

Visceral 33% 18%

9%

 

 

The following factors may provide a relatively more favorable prognosis and help guide decisions about what treatments and therapies are recommended:

 

  • A limited number of sites of melanoma metastases

  • The disease is limited to soft tissues and lymph nodes rather than bone and vital organs

  • Stage IV melanoma does not develop until more than 1 year after treatment of earlier-stage melanoma

  • A normal lactate dehydrogenase level (blood test)
  • The occurrence of an observable and favorable response to treatment

 

Additional favorable patient factors include:

 

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

 

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

 

Reference:
1. Balch CM, Final Version of 2009 AJCC Melanoma Staging and Classification, JCO, 2009