Virgo K S, Chan D, Handler B S, Johnson D Y, Goshima K, Johnson F E
Department of Surgery at Saint Louis University Health Sciences Center and the Surgical Service at John Cochran Veterans Affairs Medical Center, MO 63110-0250, USA.
Plast Reconstr Surg. 2000 Sep;106(3):590-7. doi: 10.1097/00006534-200009030-00010.
Follow-up care for patients who have undergone potentially curative resection of cutaneous melanoma varies widely among physicians, and the underlying rationale has not been assessed. To quantify current practice patterns and to discern motivation, a custom-designed questionnaire was mailed to U.S. and non-U.S. surgeons, all of whom were members of the American Society of Plastic and Reconstructive Surgeons (ASPRS). Surveys were mailed to 3,032 ASPRS members, chosen randomly from a total of 4,320 members. Of the 1,142 questionnaires that were returned, 395 were evaluable. Nonevaluability was usually due to lack of melanoma patients receiving follow-up in the surgeons' practices. Surveillance of patients after resection of melanoma relies most heavily on office visit, chest x-ray, complete blood count, and liver function tests. There was surprisingly little influence of elective node dissection on follow-up practices. Imaging tests such as computed tomography, magnetic resonance imaging, and position emission tomography scan were rarely employed. Surveillance is motivated by many factors, particularly early detection of recurrence of the index melanoma and second primary melanomas. This survey provides information regarding current follow-up strategies recommended by ASPRS surgeons after potentially curative resection of cutaneous melanoma. There is considerable variation in surveillance intensity and in motivation among practitioners, thus representing a lack of consensus.
对于接受过皮肤黑色素瘤潜在根治性切除术的患者，医生提供的后续护理差异很大，其根本原因尚未得到评估。为了量化当前的实践模式并探究动机，我们向美国和非美国的外科医生邮寄了一份定制设计的问卷，这些医生均为美国整形与重建外科医师协会（ASPRS）的成员。调查问卷被寄给了从总共4320名成员中随机挑选出的3032名ASPRS成员。在返回的1142份问卷中，有395份可用于评估。不可评估通常是由于外科医生的实践中缺乏接受随访的黑色素瘤患者。黑色素瘤切除术后对患者的监测主要依赖于门诊就诊、胸部X光、全血细胞计数和肝功能检查。令人惊讶的是，选择性淋巴结清扫对随访实践的影响很小。计算机断层扫描、磁共振成像和正电子发射断层扫描等成像检查很少使用。监测受到多种因素的推动，特别是对原发性黑色素瘤复发和第二原发性黑色素瘤的早期检测。这项调查提供了有关ASPRS外科医生在皮肤黑色素瘤潜在根治性切除术后推荐的当前随访策略的信息。从业者之间在监测强度和动机方面存在相当大的差异，因此缺乏共识。
