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NEWS & VIEWS |
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To assess the benefits of close physician follow-up and patient education, lead author L. Andrew DiFronzo, MD, and his colleagues at the John Wayne Cancer Institute (JWCI) studied 51 patients who were treated at JWCI for a melanoma and who subsequently developed a second melanoma. The patients all had information available on the thickness of both melanomas. Because these patients received follow-up exams every six months and regular patient education sessions, comparison of the thickness of initial and subsequent melanomas allowed the investigators to examine the effect of close follow-up and patient education on earlier diagnosis of second melanomas, says Donald Morton, MD, medical director and surgeon-in-chief at JWCI and one of the study’s authors.
"The thickness of the melanoma is an indication of how long it’s been there, and what the risk is of it spreading. If it’s a very thin melanoma, it’s highly curable in 95% or more of the patients—whereas if it’s a thick melanoma, the chance of a cure goes down," explains Morton.
The mean tumor thickness was 1.32 ± 1.02 mm and 0.63 ± 0.52 mm, respectively, for the initial and second melanomas. The second melanoma was thicker in only 4 (8%) of the 51 patients.
Many melanoma survivors know they are at increased risk for a second cancer and are motivated to examine their skin thoroughly and to keep their follow-up medical appointments.
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Self-Exams Can Lead to Earlier Diagnosis |
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 TOP Self-Exams Can Lead to... |
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"It’s important to remain diligent and carefully examine your skin on a regular basis," says Morton. "We advise our patients to do a total skin exam at least monthly—by themselves and by their partners looking them over carefully and charting new moles or other skin changes." Patients should inform physicians immediately of such changes.
In addition, follow-up exams with a surgical oncologist or dermatologist at least every six months will lead to early detection and improved treatment of melanomas that may arise after the first melanoma, says Morton. Careful surveillance should be continued over a lifetime. "Our standard policy is that once a patient has developed a melanoma, we follow them forever," Morton emphasizes.
Alan Geller, RN, MPH, a member of the American Cancer Society’s Skin Cancer Advisory Group and an associate professor in Boston University’s department of dermatology, agrees that these are important recommendations for physicians and for melanoma survivors, and for the general public as well. "Many melanoma survivors know they are at increased risk for a second cancer and are motivated to examine their skin thoroughly and to keep their follow-up medical appointments. If the general public could also be convinced of the importance of skin self-examination and asking their health providers for skin exams, the impact on melanoma mortality rates could be substantial. Health care providers should also be encouraged to instruct and advise their high-risk patients to carefully examine their skin for cancer."
If the general public could also be convinced of the importance of skin self-examination and asking their health providers for skin exams, the impact on melanoma mortality rates could be substantial.
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