Dear OncoLink "Ask The Experts,"
I am a 29-year-old female with melanoma, stage T2N0M0. I am getting every-3-month follow-up visits/exams with every-6-month chest x-rays & blood work. Is there any opinion on getting any routine brain scans, since melanoma's "favorite" metastasis sites are chest & brain? I do not presently have any neurological symptoms.
Keith T. Flaherty, MD, Assistant Professor of Medicine (Hematology/Oncology), responds:
The most appropriate method of following a person who has had a melanoma resected has not been sorted out. In fact, there is a great deal of debate among melanoma experts regarding the most reasonable and effective method. Having said that, there is some agreement on the basic elements.
Regular physical examination with blood work (including LDH) is considered standard. The frequency of those visits can be every six to twelve months.
Some believe that an annual chest x-ray is advisable, since the most common site of melanoma metastasis is the lung. Having said that, there is no evidence to support that this benefits patients in any way.
Having regularly scheduled CT, MRI, or PET scans is not recommended by the majority of melanoma experts, but some feel that there is a role for such scans. The brain is not the most common site of metastasis, and having brain metastasis in the absence of other sites (lung, liver, bone, etc.) is very unlikely. Therefore, routine brain scans are not recommended. CT scans of the body or PET scans are advocated by some, but not most, melanoma experts. The problem with both methods is that, in the setting of looking for recurrent melanoma, they will frequently identify abnormalities which have nothing to do with melanoma. Such findings will lead to unnecessary worry and, in some cases, biopsies and surgeries which have risks of complications.
While there is no easy answer to the question of follow-up after removal of melanoma, it is safe to say that regular physical exams with blood work are the backbone. An annual chest x-ray can be considered. Performing scans beyond that is generally not recommended. However, the ultimate decision on these issues is between the patient and his or her doctor.