An incidental finding
Pruritic patches on the patient’s trunk and extremities prompted his visit, but it was the “birthmark” on his back that was far more worrisome.
Follow-up with patients is key
Regular skin, lymph node, and general follow-up exams are recommended to detect metastatic disease or new primary lesions. It has been estimated that approximately 5% of patients with a history of melanoma will develop a new primary lesion.3 Lab and imaging studies should be used when prompted by clinical findings.2
Some protocols recommend routine use of labs, including lactate dehydrogenase, complete blood count, and chemistries, as well as imaging such as chest x-ray, positron emission tomography (PET), or computed tomography (CT) based on the stage of the disease.4 No evidence has shown that routine laboratory or imaging studies affect prognosis.2
Close surveillance for my patient
My patient underwent re-excision of the tumor site with wide margins. Sentinel lymph nodes excised from the bilateral axilla were negative for melanoma. He was seen by colleagues in the oncology department, and his lab work and chest x-ray were normal. PET/CT revealed no evidence of fluorodeoxyglucose avid metastatic disease.
Based on staging, my patient’s 5-year survival was estimated at 81% and his 10-year survival at 67%. No further oncology follow-up was planned and the patient was instructed to be seen by a dermatologist for close clinical surveillance.
CORRESPONDENCE
Suresh K. Menon, MD, Hahn Medical Practices, 5078 Williamsport Pike, Martinsburg, WV 25404; suresh10suresh@msn.com
