Perspective evaluation of a four-year period of application of a follow-up protocol for melanoma patient management

Aim. Although numerous follow-up protocols have been proposed, there are no widely accepted guidelines for melanoma (MM) follow-up. In 2000, the Emilia-Romagna Melanoma Group agreed upon guidelines for the MM follow-up, considering histological thickness and disease stage. The purpose of this study was the perspective evaluation of this follow-up protocol, in order to verify the efficacy to identify metastases and the effectiveness of the therapeutic approaches. Methods. During a 4-year period (2001-2004), 176 MM patients were supervised according to our follow-up protocol. Results. Thirty-nine patients underwent disease progression, showing in transit metastases in 15 cases, lymph node metastases in 11 cases, and distant metastases in 13 cases. At the end of the study 11 patients were dead for the complications of the disease. Disease progression was related with MM thickness, tumour stage and presence of ulceration, with a significant proportion of visceral localization in ulcerated MMs. A low rate of metastases was observed for MMs of the upper limbs, chest and abdomen. Concerning the metastasis identification, the majority of the recurrences were diagnosed by the physician, by means of instrumental examination or during clinical examination. A great part of the first recurrences underwent surgery, with a significant proportion of complete responses for locoregional ones, whereas distant metastases, although frequently diagnosed before becaming symptomatic, showed a poor response to the treatments. Conclusion. This study represents a critical intermediate analysis of the application of the Emilia-Romagna protocol after 4 years of methodical application.