Stage IIA Cutaneous Melanoma: Do Regional Ultrasound and CT scan Improve Detection of Relapses? A Multicenter Retrospective Observational Study

Giulia Briatico; Gabriella Brancaccio; Elvira Moscarella; Caterina Longo; Stefania Borsari; Roberta Ruggeri; Giovanni Docimo; Giuseppe Argenziano

doi:10.5826/dpc.1403a155

Stage IIA Cutaneous Melanoma: Do Regional Ultrasound and CT scan Improve Detection of Relapses? A Multicenter Retrospective Observational Study

Authors

Giulia Briatico Dermatology Unit, University of Campania “Luigi Vanvitelli”, Naples, Italy
Gabriella Brancaccio Dermatology Unit, University of Campania “Luigi Vanvitelli”, Naples, Italy
Elvira Moscarella Dermatology Unit, University of Campania “Luigi Vanvitelli”, Naples, Italy
Caterina Longo Department of Dermatology, University of Modena; Azienda Unità Sanitaria Locale – IRCCS di Reggio Emilia, Skin Cancer Center, Reggio Emilia, Italy
Stefania Borsari Azienda Unità Sanitaria Locale – IRCCS di Reggio Emilia, Skin Cancer Center, Reggio Emilia, Italy
Roberta Ruggeri Department of Dermatology, University of Modena; Azienda Unità Sanitaria Locale – IRCCS di Reggio Emilia, Skin Cancer Center, Reggio Emilia, Italy
Giovanni Docimo Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
Giuseppe Argenziano Dermatology Unit, University of Campania “Luigi Vanvitelli”, Naples, Italy

Keywords:

melanoma, ultrasonography, dermato-oncology

Abstract

Introduction: Stage 2A cutaneous melanoma is typified by a Breslow thickness between 1.1 and 2.0 mm with ulceration or between 2.1 and 4.0 mm without ulceration. The role of radiological investigations in staging and follow-up of this intermediate-risk subgroup of patients is still debated.

Objective: The aim of this study is to investigate the role of imaging procedures in the follow-up of stage IIA melanoma asymptomatic patients.

Methods: Data were retrieved from 2 tertiary referral centers in Italy. Among patients with stage 2A melanoma, those who relapsed were investigated concerning type of detection (by patient or by doctor), and modality of detection (clinical examination, ultrasound, CT scan). In addition, false positive data were collected.

Results: In total, 213 patients were retrieved, with 26 patients showing relapse (recurrence rate, 12.2%). The mean follow-up time was 3 years and the mean time to recurrence was 17.8 months. 21/26 (80.7%) recurrences were identified by the doctor and 5/26 (19.2%) by the patient (p<0.05). Among those identified by the doctor, 16/21 (76.1%) were identified by radiological examinations. 9/15 (60%) lymph node recurrences were detected by ultrasound and 6/7 (85.7%) distant metastases were detected by CT. The false positive rate was 7% (p<0.05).

Conclusions: In our study the great majority of metastases were detected using imaging procedures. Given the new therapeutic options offered by target therapy and immunotherapy in relapsing patients, the role of radiological investigations in the follow-up of stage 2A patients should be reconsidered.

References

Keung, E. Z. & Gershenwald, J. E. The eighth edition American Joint Committee on Cancer (AJCC) melanoma staging system: implications for melanoma treatment and care. Expert Rev. Anticancer Ther. 18, 775–784 (2018).

Garbe, C. et al. Prospective evaluation of a follow-up schedule in cutaneous melanoma patients: Recommendations for an effective follow-up strategy. J. Clin. Oncol. 21, 520–529 (2003).

Lee, A. Y. et al. Patterns and Timing of Initial Relapse in Pathologic Stage II Melanoma Patients. Ann Surg Oncol 24, 939–946 (2018).

Thomas, D. C. et al. Recurrence of Melanoma After a Negative Sentinel Node Biopsy: Predictors and Impact of Recurrence Site on Survival. Ann. Surg. Oncol. 26, 2254–2262 (2019).

Berger, A. C. et al. Patient Symptoms Are the Most Frequent Indicators of Recurrence in Patients with American Joint Committee on Cancer Stage II Melanoma. J. Am. Coll. Surg. 224, 652–659 (2017).

Argenziano, G. et al. Management of cutaneous melanoma: Comparison of the leading international guidelines updated to the 8th American Joint Committee on Cancer staging system and workup proposal by the Italian Society of Dermatology. G. Ital. di Dermatologia e Venereol. 155, 126–145 (2020).

NCCN. Melanoma : Cutaneous. (2023).

Rachael Morton, Catherine Bell, Victoria Marr, M. S. https://wiki.cancer.org.au/australiawiki/index.php?oldid=186474. Cancer Council Australia Melanoma Guidelines Working Party (2018).

AIOM. Linee guida MELANOMA Edizione 2021. (2021).

https://www.sidemast.org/blog/guideline-on-the-diagnosis-and-treatment-of-melanoma/.

Ribero, S. et al. Ultrasound-based follow-up does not increase survival in early-stage melanoma patients: A comparative cohort study. Eur. J. Cancer 85, 59–66 (2017).

Rueth, N. M. et al. Is surveillance imaging effective for detecting surgically treatable recurrences in patients with melanoma? A comparative analysis of stage-specific surveillance strategies. Ann. Surg. 259, 1215–1222 (2014).

Hengge, U. R., Wallerand, A., Stutzki, A. & Kockel, N. Cost-effectiveness of reduced follow-up in malignant melanoma. Jddg 5, 898–907 (2007).

Luke JJ, Rutkowski P, Queirolo P, Del Vecchio M, Mackiewicz J, Chiarion-Sileni V, de la Cruz Merino L, Khattak MA, Schadendorf D, Long GV, Ascierto PA, Mandala M, De Galitiis F, Haydon A, Dummer R, Grob JJ, Robert C, Carlino MS, Mohr P, Poklepovic A, Sond, A. Pembrolizumab versus placebo as adjuvant therapy in completely resected stage IIB or IIC melanoma (KEYNOTE-716): a randomised, double-blind, phase 3 trial. Lancet Apr 30;399, (2022).

Vallet, A. et al. Association of Time from Primary Diagnosis to First Distant Relapse of Metastatic Melanoma with Progression of Disease and Survival. JAMA Dermatology 155, 673–678 (2019).

Tas, F. & Erturk, K. Relapse patterns in patients with local and regional cutaneous melanoma. Clin. Transl. Oncol. 21, 412–419 (2019).

Francken, A. B. et al. Detection of first relapse in cutaneous melanoma patients: Implications for the formulation of evidence-based follow-up guidelines. Ann. Surg. Oncol. 14, 1924–1933 (2007).

Moore Dalal, K. et al. Methods of detection of first recurrence in patients with stage I/II primary cutaneous melanoma after sentinel lymph node biopsy. Ann. Surg. Oncol. 15, 2206–2214 (2008).

Damude, S. et al. The MELFO-Study: Prospective, Randomized, Clinical Trial for the Evaluation of a Stage-adjusted Reduced Follow-up Schedule in Cutaneous Melanoma Patients—Results after 1 Year. Ann. Surg. Oncol. 23, 2762–2771 (2016).

David Howard, M. Melanoma Radiological Surveillance: A Review of Current Evidence and Clinical Challenges. Yale J. Biol. Med. 93, 207–213 (2020).

Ascierto, P. A. et al. Adjuvant nivolumab versus ipilimumab in resected stage IIIB–C and stage IV melanoma (CheckMate 238): 4-year results from a multicentre, double-blind, randomised, controlled, phase 3 trial. Lancet Oncol. 21, 1465–1477 (2020).

Long, G. V. et al. Adjuvant Dabrafenib plus Trametinib in Stage III BRAF -Mutated Melanoma . N. Engl. J. Med. 377, 1813–1823 (2017).

Leiter U, Buettner PG, Eigentler TK, Forschner A, M. F. & C., G. Is detection of melanoma metastasis during surveillance in an early phase of development associated with a survival benefit? Melanoma Res 1, (2010).

Forschner A, Eichner F, Amaral T, Keim U, Garbe C, E. T. Improvement of overall survival in stage IV melanoma patients during 2011-2014: analysis of real-world data in 441 patients of the German Central Malignant Melanoma Registry (CMMR). J Cancer Res Clin Oncol. Mar;143, 533–540 (2017).

Xing, Y., Cromwell, K. D. & Cormier, J. N. Review of diagnostic imaging modalities for the surveillance of melanoma patients. Dermatol. Res. Pract. 2012, (2012).

Xing, Y. et al. Contemporary diagnostic imaging modalities for the staging and surveillance of melanoma patients: A meta-analysis. J. Natl. Cancer Inst. 103, 129–142 (2011).

Lewin, J. et al. Surveillance imaging with FDG-PET/CT in the post-operative follow-up of stage 3 melanoma. Ann. Oncol. 29, 1569–1574 (2018).

Mrazek AA, C. C. Surviving Cutaneous Melanoma: A Clinical Review of Follow-up Practices, Surveillance, and Management of Recurrence. Cancer Surg Clin North Am. 94, 989–1002 (2014).