Patients who have been diagnosed with melanoma should be routinely assessed and educated about their disease to facilitate early detection of a second melanoma, according to a recent study published in the journal Cancer.

Melanoma is a cancer of the skin that usually begins in the form of a mole. The cancer can grow deep into the skin and spread to different parts of the body through blood or lymph vessels. It usually spreads first to lymph nodes that are near the site of cancer origin and when advanced, can spread to organs and other lymph nodes throughout the body. Cure rates can be high for melanoma if the disease is caught early, before it begins to spread. Therefore, early detection is imperative in order to achieve optimal treatment outcomes.

Patients who have been diagnosed with melanoma have a 10-25 times greater risk of developing a second melanoma than the general population. As a result of this increased risk, these patients could potentially benefit from routine skin assessments designed to detect and treat a second melanoma in its earliest stages. However, prior studies have suggested that routine follow-ups for melanoma patients result in increased medical costs and were of insignificant clinical benefit1,2.

Recently, researchers at the John Wayne Cancer Institute conducted a clinical study involving over 3,000 patients who had been diagnosed with early stage melanoma between 1971 and 1999. At the time of treatment of their initial melanoma, these patients were thoroughly educated on performing self skin exams and instructed to seek medical attention if they observed any sign of a suspicious skin change. In addition, patients underwent a complete physical by a surgical oncologist and a complete skin assessment by a dermatologist every 6 months for 5 years following treatment of their initial melanoma. At five years and thereafter following treatment of the initial melanoma, patients underwent yearly physical examinations by a surgical oncologist and were advised to continue biannual examinations by a dermatologist.

Of these patients, 114 developed a second skin melanoma. Records for both melanomas were obtained in 82 of these patients. Of these 82 patients, the thickness of the second melanoma was decreased in approximately 79% of patients. Only 2 patients had a higher stage secondary melanoma than their initial melanoma. These results have led the researchers conducting this clinical study to stress the importance of education, self skin examinations and frequent follow-up for patients who have been diagnosed with melanoma. The fact that the majority of second melanomas were found at an earlier stage than initial melanomas indicates the relevance of advocating routine assessments by patient and physician in all patients who have had melanoma.

Patients with melanoma may wish to speak with their physician about obtaining specific information on self skin exams in order to detect suspicious skin changes early as well as scheduling long-term follow-up skin assessments with appropriate health-care providers.

(Cancer, Vol 91, No 8, pp 1520-1524, 2001)

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