Stage IV Follow Up

Stage IV melanoma represents melanoma that cannot be surgically removed or those that have been treated but have a very high risk of recurrence. 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

Skin Examination

Annually by healthcare provider
Monthly self-examination

Physical 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

Imaging Tests

Possibly every 3-12 months to check for recurrence

Brain MRI

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 Rates

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.
What to do if melanoma recurs

References:

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

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