Aim:
Melanoma is the third most common cancer diagnosed in Australia with an estimated incidence of 54 per 100,000 in 2020. In 2019 the Australian cancer council published guidelines for follow up of melanoma by stage. For stage IIIA-C melanoma a 3 monthly follow up is recommended for the first 2 years following diagnosis. We aim to assess current adherence to guidelines for PET surveillance in stage III and resected stage IV melanoma.
Methods:
Data was collected from all patients with stage IIIc or resected stage IV melanoma who were treated with adjuvant nivolumab in a large tertiary centre in Western Australia between 2018 to 2021. Surveillance PET scans were reviewed and the time intervals between each scan were recorded from the time of diagnosis.
Results:
In this study we recorded 45 patients with stage III or resected stage IV melanoma who were treated with adjuvant nivolumab.
The median times interval between initial PET and first follow up PET scan was 4.5 months. Almost half the group (n=20, 44%) did not have follow up in accordance with Australian guidelines. 50% (n=10) of these patients had PET surveillance at time intervals greater than the recommended time.
No recurrence was found to date in 71% of cases (n=32). Treatment was ceased in a small number of patients (n=4) due to adverse events. These included arthralgia, hepatitis, pneumonitis and rash Two of these disease recurrences were discovered on surveillance PET.
Conclusion:
In conclusion, current surveillance practices in this centre deviated from national guidelines in a large number of patients. There is minimal evidence that intensified surveillance regimes improves survival in these groups. Re-evaluation following intensified surveillance regimes should be completed to assess the impact on patient outcome.