Poster Presentation New Zealand Association of Plastic Surgeons Annual Scientific Meeting

Melanoma in Canterbury; Two year follow up of stage 3 and 4 Melanoma. Where are our patients going? (488)

James Eason 1 , Jeremy Simcock 1
  1. Plastic Surgery Department, CDHB, ChCh, CANTERBURY, New Zealand

Aim: We reviewed CDHB Plastic Surgery Department’s follow up of all stage 3 and 4 melanoma patients to identify adherence to current follow up guidelines. Further we examined each patient’s journey through oncology specialities.

Introduction: Current Australasian guidelines suggest 3-4 monthly follow up of melanoma patients for 5 years. Two developments recently, that of the Trans-Tasman Radiation Oncology Group (TROG) study (2012) and medical therapies, have provided new avenues of treatment for advanced stage melanoma and have modified follow up for our patients.

Methods: We identified all stage 3 and 4 Canterbury melanoma patients diagnosed over a 1 year period between 2012 and 2013. Follow up was examined retrospectively over 2 years.

Results: 38 patients were diagnosed with stage 3 or 4 melanoma. 22 patients survived 2 years and were included in the study. All patients were initiated on 3 monthly follow up. 50% of patients completed radiotherapy for local control of metastasis. 40.9% of patients were started on medical therapies. Over the course of the 2 year follow up 45.5% of patients were discharged from plastic surgery to oncology teams. 2 patients were discharged to their GP before 1 year of follow up was completed. 5 patients were not followed up for 10 months or more.

Conclusion: Our follow up currently meets recommendations with some exceptions. Patients having missed follow up appointments were largely due to medical complications. Radiotherapy and immunomodulation therapy now forms a large part of treatment for this patient group. This is due to the results of the TROG study (2012) and increased access to medical therapy trials. The result is large numbers of patients being discharged from Plastics to Oncology.

  1. Burmeister BH. et al. Adjuvant radiotherapy versus observation alone for patients at risk of lymph-node field relapse after therapeutic lymphadenectomy for melanoma: a randomised trial. Lancet Oncol. 2012 Jun;13(6):589-97.
  2. Thompson JF, Shaw HM, Stretch JR, et al. The Sydney Melanoma Unit--a multidisciplinary melanoma treatment center. Surg Clin North Am. 2003;83:431–51.
  3. Francken AB, Accortt NA, Shaw HM, et al. Follow-up schedules after treatment for malignant melanoma. Br J Surg. 2008;95:1401–7.
  4. Australian Cancer Network Melanoma Guidelines Revision Working Party. Clinical Practice Guidelines for the Management of Melanoma in Australia and New Zealand. Cancer Council Australia and Australian Cancer Network, Sydney and New Zealand Guidelines Group, Wellington. 2008.