Follow-up in stage I cutaneous malignant melanoma: an audit

In Southampton, follow-up of patients with malignant melanoma is carried out in a single dedicated clinic. An audit has been performed to assess its objective value in diagnosing and treating tumour relapse and its subjective value as perceived by patients. Over a 10-year period, of 331 patients with Stage I disease 65 (20%) have developed tumour recurrence. Fifty-five first relapses were either local or in regional lymph nodes, and thus potentially curable; half were found within 3 months of the previous clinic visit. Seventy-two per cent of local and 47% of nodal recurrences were either symptomatic or detected initially by the patient. Whilst doctor-diagnosed nodal recurrences tended to be smaller and to involve fewer histologically positive nodes, subsequent survival was identical in those with patient-diagnosed nodal recurrences. The clinic makes inefficient use of medical time. Questionnaire responses indicate that 54% of patients suffer anxiety prior to clinic visits. Nevertheless follow-up was considered worthwhile by 95% of patients and regular visits were preferred to a 'walk in when necessary' system. The clinic appears to have an important educational role. A series of changes to current follow-up practice are proposed including: more frequent visits for high risk patients, changes in clinic personnel, and greater emphasis on patient education and self examination.