SANTA BARBARA, CALIF. — Secondary primary melanomas occur in 2.3% of patients, compared with a 1% incidence of primary melanoma in the white population.
That difference is high enough to justify annual skin examinations throughout life for any patient with a history of melanoma, said Dr. June K. Robinson, chief of dermatology at Dartmouth-Hitchcock Medical Center, Hanover, N.H.
The checks should be at shorter intervals in the years immediately following a melanoma diagnosis, she explained at the annual meeting of the California Society of Dermatology and Dermatologic Surgery.
Patients with stage IA melanoma should receive a history and physical every 6 months for 2 years, then annually, she said. Those with stage IB through stage III should receive a history and physical, chest x-ray, and lactic dehydrogenase (LDH) screen every 3–6 months for 3 years, then every 6–12 months for 2 years, and then annually.
The timing of the examinations is admittedly guesswork, Dr. Robinson said. “More than anything else, you're hand-holding. You're a stable presence for them,” Dr. Robinson said.
An overlooked benefit of follow-up examinations is the opportunity to identify and educate family members who often do not realize that they need to protect themselves and perform regular skin self-examinations.
If a family member accompanies a melanoma survivor to an appointment, Dr. Robinson speaks directly about elevated risk in family members and preventive steps that can be taken.
Patients who come alone can be counseled to speak with their siblings, children, and grandchildren about melanoma risk, tanning booths, sun protection, and the importance of skin self-examination and regular screening, she said.