Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030-4009, USA.
Melanoma Res. 2012 Oct;22(5):376-85. doi: 10.1097/CMR.0b013e328357d796.
There are no evidence-based guidelines for the surveillance of patients with melanoma following surgical treatment. We carried out a systematic review to identify by country and physician specialty the current stage-specific surveillance practices for patients with melanoma. Three major medical indices, MEDLINE, the Cochrane Library database, and Scopus, were reviewed to identify articles published from January 1970 to October 2011 that included detailed information about the surveillance of patients with melanoma after the initial surgical treatment. Data on surveillance intervals and recommended evaluation were extracted and categorized by country and, when reported, physician specialty. One hundred and four articles from 10 countries and four physician specialties (dermatology, surgical oncology, medical oncology, and general practice) fulfilled the inclusion criteria, including 43 providing specific patient-level data. The articles showed a wide variation with respect to the surveillance intervals and recommended evaluations. The variation was greatest for patients with stage I disease, for whom the follow-up frequency ranged from one to six visits per year during years 1 and 2 after treatment. All four physician specialties agreed that for years 1-3, the follow-up frequency should be four times per year for all patients. For years 4 and 5, surgical oncologists recommended two follow-up visits per year, whereas general practitioners, dermatologists, and medical oncologists recommended four visits per year. Recommended imaging and laboratory evaluations were most intense in the UK and most minimalist in the Netherlands. Although general practitioners did not recommend routine laboratory or imaging tests for surveillance, all other specialties utilized both in their surveillance practice. Self skin-examination was recommended for surveillance in all countries and by all practitioner specialties. There are significant intercountry and interspecialty variations in the surveillance of patients with melanoma. As the number of melanoma survivors increases, it will be critical to examine the benefits and costs of various follow-up strategies to establish consensus guidelines for melanoma post-treatment surveillance.
目前尚无循证医学指南来指导黑色素瘤患者术后的随访。我们进行了一项系统评价，旨在确定不同国家和医生专业领域黑色素瘤患者的当前特定阶段随访实践。我们对三大医学索引，即 MEDLINE、Cochrane 图书馆数据库和 Scopus，进行了检索，以确定自 1970 年 1 月至 2011 年 10 月发表的、包含黑色素瘤患者初始手术治疗后随访详细信息的文章。我们提取了随访间隔和推荐评估的数据，并按国家和（如有报告）医生专业进行了分类。有 104 篇来自 10 个国家和 4 个医生专业（皮肤科、外科肿瘤学、内科肿瘤学和普通科）的文章符合纳入标准，其中 43 篇提供了具体的患者水平数据。这些文章显示出在随访间隔和推荐评估方面存在很大差异。Ⅰ期疾病患者的随访差异最大，他们在治疗后 1 年和 2 年内的随访频率为每年 1 至 6 次。所有 4 个医生专业都认为，在 1-3 年内，所有患者的随访频率应为每年 4 次。在第 4 年和第 5 年，外科肿瘤学家建议每年随访 2 次，而普通科医生、皮肤科医生和内科肿瘤学家建议每年随访 4 次。英国推荐的影像学和实验室评估最为密集，荷兰则最为简化。尽管普通科医生不建议将常规实验室或影像学检查用于监测，但其他所有专业都将其纳入了监测实践中。所有国家和所有医生专业都建议进行自我皮肤检查以进行监测。黑色素瘤患者的随访在不同国家和不同专业之间存在显著差异。随着黑色素瘤幸存者人数的增加，有必要研究各种随访策略的效益和成本，以制定黑色素瘤治疗后随访的共识指南。
