Staging work-up and surveillance after treatment of melanoma
- Antonio C Buzaid, MD
Antonio C Buzaid, MD
- Chairman, Steering Committee Member
- Centro Oncológico
- Hospital Israelita Albert Einstein, Brazil
- Jeffrey E Gershenwald, MD, FACS
Jeffrey E Gershenwald, MD, FACS
- Professor of Surgery and Cancer Biology
- The University of Texas MD Anderson Cancer Center
- Section Editors
- Michael B Atkins, MD
Michael B Atkins, MD
- Section Editor — Malignant Melanoma and Other Cutaneous Neoplasms; Cancer of the Kidney
- Deputy Director
- Georgetown Lombardi Comprehensive Cancer Center
- Hensin Tsao, MD, PhD
Hensin Tsao, MD, PhD
- Section Editor — Melanocytic Lesions and Disorders of Pigmentation
- Professor of Dermatology
- Harvard Medical School
Laboratory tests and imaging studies are necessary to accurately stage patients with cancer prior to definitive treatment. However, the staging evaluations used for cancer patients both at the time of initial diagnosis and for follow-up after the initial treatment are often excessive. There are few, if any, established guidelines that define the appropriate tests for the initial evaluation and subsequent follow-up in patients with melanoma.
Practical stage-specific guidelines for the evaluation and follow-up of patients with melanoma are presented here. The melanoma staging system and a review of imaging studies useful in the evaluation of melanoma are presented separately. (See "Tumor node metastasis (TNM) staging system and other prognostic factors in cutaneous melanoma" and "Imaging studies in melanoma".)
CLINICAL STAGE I AND II
Melanoma has the potential to metastasize to any organ; common sites of dissemination include the skin, subcutaneous tissues, lymph nodes, lung, liver, bone, brain, and visceral organs.
However, there is no role for routine imaging studies beyond sentinel lymph node mapping and biopsy in asymptomatic patients with clinical stages I and II disease (table 1A-B), as the identification of metastatic disease in this setting is negligible:
●Lymphatic mapping and sentinel lymph node biopsy – The indications for lymphatic mapping and sentinel lymph node (SLN) biopsy in patients with clinical stage I and II disease are discussed separately. (See "Evaluation and treatment of regional lymph nodes in melanoma".)
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- CLINICAL STAGE I AND II
- STAGE III DISEASE
- Positive sentinel lymph node
- Clinical stage III and local recurrence
- STAGE IV
- SURVEILLANCE AFTER TREATMENT
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS
- Clinical stages I and II
- Positive SLNs (pathologic stage III)
- Clinical stage III disease
- Surveillance after definitive treatment
- Stage IV disease