COST-EFFECTIVENESS OF SURVEILLANCE OF STAGE-I MELANOMA - A RETROSPECTIVE APPRAISAL BASED ON A 10-YEAR EXPERIENCE IN A DERMATOLOGY DEPARTMENT IN FRANCE

Background: There is no agreement about surveillance after resection of a stage I melanoma. Objective: We assessed the cost-effectiveness of this surveillance. Methods: Out of 912 patients with stage I (and Clark's level greater than or equal to II) melanoma examined from 1981 to 1991, only 528 were regularly followed in our department. Results: 115 out of 528 relapsed; 33% were detected by the patient himself, 16% by the referring physician and 39% were detected in our department. Chest X-ray or abdomen ultrasonography revealed only 10% of relapses; CT scans were useless. There was a huge gap between the cost-effectiveness of clinical examinations and radiology. The time between relapse and the last check-up in our department was less than 4 months in one third of the metastases. Conclusions: In stage I melanoma, only clinical examination is really cost-effective in the detection of metastases. However, many metastases are likely to become prominent between two examinations if patients are examined less than 3 times a year. A progressive decrease in frequency is thus not advisable, until the risk is considered low enough to stop follow-up.