Bassères N, Grob J J, Richard M A, Thirion X, Zarour H, Noe C, Collet-Vilette A M, Lota I, Bonerandi J J
Laboratoire d'Investigations sur les Maladies de la Peau, Hôpital Ste-Marguerite, Marseille, France.
Dermatology. 1995;191(3):199-203. doi: 10.1159/000246546.
There is no agreement about surveillance after resection of a stage I melanoma.
We assessed the cost-effectiveness of this surveillance.
Out of 912 patients with stage I (and Clark's level > or = II) melanoma examined from 1981 to 1991, only 528 were regularly followed in our department.
115 out of 528 relapsed; 33% were detected by the patient himself, 16% by the referring physician and 39% were detected in our department. Chest X-ray or abdomen ultrasonography revealed only 10% of relapses; CT scans were useless. There was a huge gap between the cost-effectiveness of clinical examinations and radiology. The time between relapse and the last check-up in our department was less than 4 months in one third of the metastases.
In stage I melanoma, only clinical examination is really cost-effective in the detection of metastases. However, many metastases are likely to become prominent between two examinations if patients are examined less than 3 times a year. A progressive decrease in frequency is thus not advisable, until the risk is considered low enough to stop follow-up.
对于I期黑色素瘤切除术后的监测尚无统一意见。
我们评估了这种监测的成本效益。
在1981年至1991年间检查的912例I期（且Clark分级≥II级）黑色素瘤患者中，只有528例在我们科室接受定期随访。
528例中有115例复发；33%由患者本人发现，16%由转诊医生发现，39%在我们科室发现。胸部X线或腹部超声仅发现10%的复发；CT扫描无用。临床检查和放射学检查的成本效益存在巨大差距。三分之一的转移灶复发与在我们科室最后一次检查的时间间隔不到4个月。
在I期黑色素瘤中，只有临床检查在检测转移灶方面真正具有成本效益。然而，如果患者每年检查少于3次，许多转移灶可能在两次检查之间变得明显。因此，在风险被认为足够低可以停止随访之前，逐渐减少检查频率是不可取的。
