Surveillance of Patients with Stage I, II, III, or Resectable IV Melanoma Who Were Treated with Curative Intent

Guideline Objective

To update the 2015 guideline of the Program in Evidence-Based Care (PEBC) Ontario Health (Cancer Care Ontario) to provide guidance for managing surveillance of patients with stage I, II, III, or resectable IV melanoma who are clinically disease-free after treatment with curative intent (following the definition of American Joint Committee on Cancer [AJCC] Pathological Prognostic Stage Groups in the 2017 Cancer Staging Manual, the 8th edition).

Patient Population

These recommendations apply to patients with stage I, II, III, or resectable IV melanoma who are clinically disease-free after treatment with curative intent. Pathological staging is according to the 8th edition AJCC staging system (Appendix 1) [1].

Intended Guideline Users

Intended users of this guideline are medical oncologists, dermatologists, surgical oncologists, radiation oncologists, family doctors, and other clinicians who are involved in the follow-up care of patients with melanoma in the province of Ontario.

Research Question(s)

1. For adult patients (≥18 years old) with stage I, II, III, or resectable IV melanoma who are clinically disease-free after receiving curative-intent treatment:
   
   1. Which follow-up evaluations (i.e., clinical follow-up, laboratory tests, photo-surveillance, dermoscopy and imaging) are optimal to improve patient outcomes (e.g., survival, recurrence, side effect from imaging examinations, and patient-reported outcomes)?
   2. At what frequency should these evaluations be performed to improve patient outcomes?
   3. Which follow-up evaluations (i.e., clinical follow-up, photo-surveillance, and dermoscopy) are optimal to detect a new primary melanoma and improve patient outcomes?
   4. At what frequency should these evaluations be performed to detect new primary melanomas and improve patient outcomes?
2. When can these patients be transitioned to primary care for follow-up?