Mercy's Dr. Vadim Gushchin Discusses Following Up After Melanoma Treatment
Many patients who underwent treatment for melanoma of the skin understandably worry about the possibility of the cancer coming back. A common strategy to diagnose possible recurrence early and deal with the patient’s anxiety about recurrence is to frequently follow-up with the oncologist. At the same time, seeing the doctor often may be concerning and costly. This dilemma was addressed in a recent paper by a group of European researchers. Dr. Vadim Gushchin, a surgical oncologist and the Director of The Melanoma & Skin Cancer Center at Mercy, comments on the article.
Q: What are the main differences between the conventional follow-up schedule and the experimental follow-up schedule?
A: The intensive follow-up is the current standard of care in the Netherlands. It consists of 4 visits to the doctor a year the first year after removing melanoma and 2-3 visits a year the following four years, depending on the stage of the disease. The reduced frequency experimental schedule requires 1-3 visits to the doctor per year, a 27% reduction.
Q: Will a follow-up schedule with less intensity increase my risk of recurrences?
A: This paper reports that there was no difference in melanoma recurrence between more intensive (4 times per year) and less intensive (1-3 times per year) surveillance groups in the first year after the surgery for melanoma. In both groups, 8 out of 100 patients physicians discovered that melanoma had come back. The researchers concluded that less intensive follow-up is safe.
Q: Will I receive professional instruction on how to complete self-inspections?
A: The patients in the study received a comprehensive yet simple guide on how to perform a self-exam and what symptoms to look for to pick up recurrence of melanoma. These instructions are reproducible and are to be implemented during the counseling of melanoma patients after the initial treatment.
Q: How much money could I save if I chose a follow-up schedule with less intensity?
A: This paper studied the cost of melanoma follow-up for the Netherlands’ medical system. The intensive follow-up had a price tag of 762 Euro per patient per year, and the less intensive follow-up – 418 Euro per patient per year. In the US, the follow-up visit's cost varies significantly, depending on the patient’s insurance and the doctor’s practice. The out-pocket payment for the visit could range from none to $300 (if the patient does not have any medical insurance coverage). It is also essential to factor in the cost of the procedures, X-rays, and lab work that these visits may trigger and indirect losses from missing work, cost of transportation, etc.
Q: Considering all the pros and cons, which follow-up schedule would you recommend?
A: The study supports that reduced frequency follow-up does not worsen melanoma outcomes; patients like it, and the health care costs go down. However, this experimental follow-up schedule requires patient education and good social support to be implemented. Also, more time is needed to ensure that the findings will hold in the long run.
Q: Is the reduced frequency follow-up recommended for all stages/severities of all melanomas?
A: The researchers studied only stages IB-IIC, and the strategy of reduced frequency follow-up could not be recommended for patients with more advanced melanoma, stages IIIA and above.
In conclusion, patients educated in self-exam with stage I and II melanoma could follow-up with the oncologist 1-3 times a year safely. It reduces medical costs and anxiety.
Dr. Vadim Gushchin leads a multidisciplinary team of experts at The Melanoma and Skin Cancer Center at Mercy to treat a wide range of skin cancers. He offers expertise in the Isolated Limb Infusion technique, a treatment aimed at preserving an arm or leg that has been aggressively attacked by skin cancer. Isolated Limb Infusion, also known as ILI, offers patients a remarkable alternative approach to metastatic melanoma on a limb.
Find more of Dr. Gushchin’s posts regarding melanoma and related issues by visiting the For C.A.R.E. site at https://www.facebook.com/forcarecharity/. The For C.A.R.E. is a 501 (c) 3 non-profit founded in 2018 to help raise awareness, provide education, and hope to those diagnosed with melanoma.
Founded in 1874 in downtown Baltimore by the Sisters of Mercy, Mercy Medical Center is a 183-licensed bed acute care university-affiliated teaching hospital. Mercy has been recognized as a top Maryland hospital by U.S. News & World Report; a Top 100 hospital for Women’s Health & Orthopedics by Healthgrades; is currently A-rated for Hospital Safety (Leapfrog Group), and is recognized by the American Nurses Credentialing Center as a Magnet Hospital. Mercy Medical Center is part of Mercy Health Services (MHS), the parent of Mercy’s primary care and specialty care physician enterprise, known as Mercy Personal Physicians, which employs more than 200 providers with locations in Baltimore, Lutherville, Overlea, Glen Burnie, Columbia and Reisterstown. For more information about Mercy, visit www.mdmercy.com, MDMercyMedia on Facebook, Twitter, or call 1-800-MD-Mercy.