Stage IV Follow-Up

After treatment, all patients with Stage IV melanoma should receive a physical examination, including a skin examination, using the following schedule. Depending upon the circumstances, follow-up for patients may be required monthly or even weekly. Regular chest x-rays, CT scans of the trunk and pelvis, and brain MRI may also be recommended.

Type of Follow-upDescription

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.

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, PET/CT scan, and 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 no symptoms.

Survival Rates

The 5-year survival rate is about 15% to 20%. The 10-year survival is about 10% to 15%.

No new data about Stage IV survival is available. It is anticipated that as more patients use the recently approved treatments and even better treatments become available, Stage IV survival will continue to improve.

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. There are patients who survive melanoma long-term. The survival prognosis is better if the melanoma has spread to only distant parts of the skin or distant lymph nodes rather than to other organs, and if the LDH level is normal.

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

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

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