Follow-up Protocol for Patients with Melanoma T1B and Negative Sentinel Lymph Node

Recommended Follow-up Program

• The National Comprehensive Cancer Network recommends a follow-up with dermatological visits every 3-12 months for the first 5 years and subsequently once a year for life, with particular attention to skin and regional lymph node examination 1, 2
• Complete clinical examination with particular attention to skin and regional lymph nodes every 3-12 months for the first 5 years and subsequently once a year, as recommended by the National Comprehensive Cancer Network 1, 3
• Monthly self-examination of skin and lymph nodes by the patient, with adequate instruction on technique, as suggested by the European Society for Medical Oncology 2, 4

Factors to Consider

• The frequency of follow-up should be adapted based on individual risk factors such as skin type, family history, presence of dysplastic nevi, and history of non-melanoma skin cancer, according to the National Comprehensive Cancer Network 1, 3
• The risk of recurrence is higher in the first 2-4 years after diagnosis, but late recurrences (≥10 years) are also documented, as reported by the National Comprehensive Cancer Network 1, 5

Patient Instructions

• Educate the patient on the importance of monthly self-examination of skin and lymph nodes, as recommended by the European Society for Medical Oncology 2, 4
• Instruct the patient on sun protection and avoiding sunburn and prolonged exposure to UV solar or artificial radiation, as suggested by the European Society for Medical Oncology 2, 4
• Inform the patient that family members have an increased risk of melanoma (4-8% risk of developing a second primary melanoma), according to the National Comprehensive Cancer Network 1, 2

Non-Routine Exams

• Routine radiologic exams (chest radiography, CT, PET) are not recommended for patients with melanoma T1B and negative sentinel lymph node, as stated by the National Comprehensive Cancer Network 3, 5
• Follow-up is not necessary for patients with in situ melanoma, since there is no risk of metastasis, according to the British Association of Dermatologists 6