Melanoma: New Insights in Follow-up & Staging

With a rising incidence of melanoma worldwide, the number of patients in clinical follow-up will keep on rising as well. In an era of economic cuts, this growing number of patients can become a great burden for health care institutions. The unpredictable character of melanoma makes it difficult to manage and standardize follow-up regimes. This thesis focuses on different aspects of melanoma follow-up. The MELFO-study, a randomized, clinical trial, comparing a reduced follow-up schedule to the currently advised high-intensity surveillance for melanoma patients. After 1 year, this did not negatively affect patients’ mental well-being, nor the detection rate of recurrences, and seems economically favorable. Patients’ preferences regarding information and education on melanoma and self-inspection of the skin and lymph nodes were questioned, after watching instructional YouTube videos. Patients’ knowledge on melanoma and their own tumor characteristics appeared to be insufficient, showing the importance of patient-tailored education. Although the sentinel lymph node biopsy (SLNB) is a generally accepted diagnostic procedure, regional differences in standardly performing the SLNB throughout the Netherlands were found. Factors associated with an increased risk of additional lymph node metastases after SLNB were identified, from which a prediction tool for patient selection for subsequent surgery (completion lymph node dissection) was distracted. The protein S-100B is currently the most specific tumormarker for melanoma. Falsely elevated S-100B blood-levels were measured after performing a venipuncture with a subcutaneous route in healthy volunteers. However, this possible adipocyte contamination in regular venipunctures does not seem to be of clinical relevance for melanoma patients