Recurrent skin cancers more likely to be found by patient self-checks than by imaging

Patients and their physicians detect more recurrences of melanoma than routine surveillance imaging does, according to a study published online Feb. 8 in the Journal of the American College of Surgeons.

Adam Berger, MD, of Thomas Jefferson University in Philadelphia, and colleagues queried melanoma databases at two academic medical centers, zeroing in on the cases of 581 patients who were diagnosed with stage II melanoma between 1996 and 2015 and had at least one year of follow-up.

In the cases involving recurrence, the team looked at the location of first recurrence and recorded whether it was detected by routine surveillance imaging, physician exam or patients presenting with symptoms.

Analyzing the results, they found that 171 patients (29.4 percent) developed recurrence, with incidence increasing significantly by stage sub-group.

As for mode of detection, patient symptoms led the way with 40 percent, followed by physician exam (30 percent) and surveillance imaging (26 percent).

Significant predictors of recurrence included male sex, ulceration and stage, while regional nodes were the most common site of recurrence, followed by lung and in-transit, the authors report.

They further conclude that, given the prevalence of regional nodal recurrences, ultrasound may prove an important part of early recurrence-detection strategy.

In a press release sent by the American College of Surgeons, Berger says the fact that imaging picked up 26 percent of patients with recurrence is notable “because it is a little higher than what we’ve seen in the past, which I think reflects the current trend to do more imaging in general. There is a move to use CT scans and other imaging techniques as an important strategy in early recurrence detection.”

Berger says he hopes the findings will help inform future follow-up guidelines on recurrent melanoma screening.