Follow up
Cutaneous melanoma (SIGN)
Routine follow up and imaging of patients with melanoma should be offered in line with the NHSScotland Cutaneous Melanoma National Follow-Up guideline.
Patients should have a holistic needs assessment at regular intervals during follow up to support their physical and mental wellbeing.
NHSScotland Cutaneous Melanoma National Follow Up Guideline surveillance schedule
Stage |
Risk |
Clinical review |
Imaging |
| IA | Low |
Dermatology/surgical clinic Every 3–6 months for 12 months |
|
| IB-IIA | Low |
Dermatology/surgical clinic Every 3–4 months for years 1–3 Every 6 months for years 4–5 |
|
|
IIIA with <1mm SLN deposit Also earlier stages where SLNB considered appropriate but unable to complete. |
Low |
Dermatology/surgical clinic Every 3–4 months for years 1–3 Every 6 months for years 4–5 |
Ultrasound of nodal basin (if available) Every 6 months for years 1–3 Annually for years 4–5 (if not having CLND and not having cross-sectional imaging follow up) |
|
IIB, IIC, IIIA (with >1mm deposit), IIIB
Also earlier stages with high-risk features (eg primary mitotic rate) *Patients on adjuvant treatment see below |
Moderate |
Dermatology/surgical clinic Every 3–4 months for years 1–3 Every 6 months for years 4–5 Annually for years 6–10 |
Baseline: CE-CT HCAP Years 1–3: 6-monthly CE-CT HCAP Years 4–5: Annual CE-CT HCAP (include neck in all CTs if primary drainage is into the head or neck) |
|
IIIC *Patients on adjuvant treatment see below |
High |
Oncology and dermatology/surgical clinics Every 3 months for years 1–2 Every 6 months for years 3–5 Annually for years 6–10 |
Baseline: CE-CT HCAP Years 1–3: 6-monthly CT HCAP Years 4–5: Annual CE-CT HCAP (include neck in all CTs if primary drainage is into the head or neck) |
|
IIID or fully resected IV *Patients on adjuvant treatment see below |
Very high |
Oncology and dermatology/surgical clinics Every 3 months for years 1–2 Every 6 months for years 3–5 Annually for years 6–10 |
Baseline: CE-CT HCAP Year 1: 3-monthly CE-CT HCAP Years 2–3: 3–6 monthly CE-CT HCAP Years 4–5: Annual CE-CT HCAP (include neck in all CTs if primary drainage is into the head or neck) Note: brain imaging 6-monthly in years 1–3, unless resected brain metastases then MRI 3-monthly in year 1 and 3–6 monthly in years 2–3, and annual in years 4–5 |
| Unresectable III/IV | Very high |
Oncology clinic may need to be tailored to individual. Completed SACT: Every 3 months for years 1–3 Every 6 months for years 4–5 Annually for years 6–10 |
Baseline: CE-CT HCAP On SACT treatment: Years 1–2: CE-CT HCAP 3-monthly (brain imaging 6-monthly unless brain metastases) Years 3 and beyond: CE-CT HCAP 6-monthly
End of treatment: If residual disease seen on CT or if disease only seen on PET** then PET followed by: Years 1–3: CT CAP months 3, 6, 12, 18, 24, 30, 36. Include 6-monthly CE-CT H Years 4–5: Annual CE-CT CAP include CT H at year 5 (include neck to all CTs if primary or metastases in the head or neck. If had SRS or brain surgery image with MRI to head) |
CE-CT HCAP – contrast-enhanced computed tomography of the head, chest, abdomen and pelvis;
CLND - completion lymphadenectomy; SACT – systemic anticancer therapy; SRS - stereostatic radiosurgery
*For patients on adjuvant systemic therapy, surveillance body scans are recommended every 3–4 months and head scans every 6 months whilst on treatment, and then as above after treatment, based on their stage.
** All PET-CTs should be considered on a patient-by-patient basis, ideally with MDT discussion.