Cost-effectiveness of surveillance of stage I melanoma. A retrospective appraisal based on a 10-year experience in a dermatology department in France

• Published in: Dermatology (Basel) Vol. 191; no. 3; p. 199
• Main Authors: Bassères, N, Grob, J J, Richard, M A, Thirion, X, Zarour, H, Noe, C, Collet-Vilette, A M, Lota, I, Bonerandi, J J
• Format: Journal Article
• Language: English
• Published: Switzerland 1995
• Subjects: Cost-Benefit Analysis; Female; Follow-Up Studies; France; Humans; Lymphatic Metastasis - pathology; Lymphatic Metastasis - prevention & control; Male; Melanoma - diagnostic imaging; Melanoma - economics; Melanoma - prevention & control; Melanoma - secondary; Neoplasm Recurrence, Local - diagnostic imaging; Neoplasm Recurrence, Local - economics; Neoplasm Recurrence, Local - prevention & control; Neoplasm Staging; Population Surveillance; Radiography, Thoracic - economics; Retrospective Studies; Risk Factors; Skin Neoplasms - diagnostic imaging; Skin Neoplasms - economics; Skin Neoplasms - prevention & control; Tomography, X-Ray Computed - economics; Ultrasonography - economics
• ISSN: 1018-8665
• 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.