Available online 10 April 2024, 102077

The first journal publication of a systematic review on surveillance in melanoma.

A reduced follow-up schedule may be feasible for stage IA–IIC melanoma.

Annual/biannual CT/PET-CT may be suitable in stage IIIA-D as clinically indicated.

Established individual risk of recurrence is the key to surveillance protocols.

Appropriate surveillance of patients with melanoma treated with curative intent is vital to improve patient outcomes. A systematic review was conducted to capture locoregional recurrence and metastatic disease, and to evaluate the effectiveness of various surveillance strategies.

MEDLINE, EMBASE, PubMed, Cochrane Database of Systematic Reviews, and National Cancer Institute Clinical Trials Database were searched. Randomized controlled trials (RCTs) and comparative studies reporting at least one patient-related outcome were included. Exclusion criteria included: published in non-English or recruited >20% or an uncertain percentage of non-target patients without conducting a subgroup analysis. This review was registered at PROSPERO (CRD42021246482).

Among 17,978 publications from the literature search, one RCT and five non-randomized comparative studies comprised 4,016 patients. The aggregate evidence certainty was low for the RCT and very low for the comparative studies, as assessed by the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach. For patients with stage IA–IIC melanoma, a reduced follow-up schedule with clinical follow-up strategies alone may be safe and cost-effective. For stage IIC–IIIC patients, at least two serial PET/CT or whole-body CT and brain MRI imaging within a median follow-up of 31.2 months may detect 50% of recurrences that lead to additional management, such as surgery. PET/CT may have a higher positive predictive value and lower false positive rate compared with CT alone in detecting recurrence in stage I–III patients.

Surveillance protocols should be based on individual risk of recurrence and established best practices when formulating follow-up strategies, as suggested by the studies reviewed. Future high-quality studies are needed to clarify the frequency of imaging follow-up strategies, especially in high-risk stage II patients.

Melanoma

Surveillance

Systematic review

© 2024 The Author(s). Published by Elsevier Ltd.