Melanoma: the Impact of Staging on Treatment, Prognosis & Follow-up

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    Abstract

    Melanoma is increasing in the Netherlands and diagnosis is made at an increasingly earlier stage, resulting in a more favorable prognosis. Currently, 5-year survival rate is 92%.

    Melanoma diagnostics, treatment and follow-up can further increase this percentage. PhD student Eric Deckers therefore conducted research, specifically into the sentinel-node procedure (SLNB), the use of tumor markers and nuclear imaging, the frequency of follow-up and the effect of obesity on disease progression and survival in melanoma.

    The SLNB can determine metastases in a minimally invasive manner, so that the correct melanoma treatment can be performed. The SLNB is currently only performed at 65% for eligible patients in the Netherlands. A further implementation up to 80 (breast cancer) seems necessary.

    Follow-up checks of high-risk melanoma patients without complaints, increased blood levels of the tumor markers S-100B and LDH may be an indication for performing a PET/CT scan to detect early metastases and initiate treatment.

    A RCT showed that a less frequent follow-up than recommended in the current guideline for SLNB-staged melanoma patients 3-years after diagnosis, is associated with fewer stress symptoms, comparable anxiety and quality of life. Less frequent follow-up is safe in the sense of detecting recurrences, survival and it reduces the follow-up costs with 39%.

    Obesity does is not associated with recurrence-free and overall-survival. A multi-center study is needed to confirm or invalidate this result.

    The improvements in melanoma diagnostics with SLNB, tumor markers, PET/CT and stage-based follow-up schedules contribute to better, cost-effective melanoma treatment and quality of life.
    Original languageEnglish
    QualificationDoctor of Philosophy
    Awarding Institution
    • University of Groningen
    Supervisors/Advisors
    • Hoekstra, Harald, Supervisor
    • Hoekstra-Weebers, Josette, Co-supervisor
    • Kruijff, Schelto, Co-supervisor
    • van de Wiel, Harry, Assessment committee
    • Hospers, Geke, Assessment committee
    • Tollenaar, R.A.E.M., Assessment committee, External person
    Award date26-Oct-2020
    Place of Publication[Groningen]
    Publisher
    Print ISBNs978-94-6402-178-3
    Electronic ISBNs978-94-6402-203-2
    DOIs
    Publication statusPublished - 2020

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