Surveillance
STAGE IIB - IIIB
- Biannual dermatology review (GPO derm ok – Dr. Stephen Wright, Dr. Lori Adamson, Dr. Erin Sullivan) 10% lifetime risk of metachronous melanoma
- H/P q 3 months X 2-3 years then q 6 monthly to complete 5 years of surveillance
- MRI Brain q 6 monthly X 3 years, optional to do annually at years 4,5
- U/S of nodal basin q 6 monthly X 2-3 years.
- CT C/A/P q 6 monthly (alternate with u/s initially) X 3 years, then annually years 4,5
- Prefer to alternate U/S and CT at 3 monthly intervals
- Monthly patient self exam of skin, scar and nodal basin
- Labs: LDH, Cr/BUN prior to each H/P
- Consider d/c patient back to GP after 3 years f/u for years 4,5 surveillance
- Lifestyle: encourage aerobic activity, UVA/UVB avoidance
STAGE IV Monitoring
- IO panel prior to each cycle, q 3 months X 1 year post completion
- Imaging on IO: first CT C/A/P/brain scan at 8-9 week mark. If progression repeat CT at 4 weeks to r/o pseudoprogression
- For IO responders, continue CT C/A/P and brain q 3 monthly initially, may gradually increase imaging to q 4 monthly, up to q 6 monthly.
- For TT first scan (CT C/A/P and brain) at 2 months…if IO is an option on progression continue q2-3 monthly and watch LDH like a hawk
- For TT responders where IO is not an option on progression can increase interval of imaging up to q 6monthly for responders
- Resected stage IV survey as per stage IIB/III
*Historically Dr. Humphreys offered patients stages IIA-IIID surveillance
MONITORING CONSIDERATIONS
- IO: IO panel prior to each cycle and then prior to q 3 monthly H/P for 1 year post adj IO
- IO: Avoid CBD/cannabis as this abrogates response rates. Tylenol also decreases effect of immunotherapy.
- TT: baseline derm exam and then derm review at 8 weeks, then q 12 weekly
- TT: ECG at baseline then q monthly X 3 to monitor QTc
- TT: ECHO (preferred) or MUGA baseline and q 3 months
- Encorafenib/binimetinib: higher rates of optho AEs (serous retinopathy, CRVO), consider ophtho at baseline and low threshold to refer to ophtho urgently for any visual change
TT = Targeted Therapy
IO = Immunotherapy
Dr. Michael Humphreys
In The Pipeline
- Watch this space
