What are the recommended follow-up schedules for melanoma, Squamous Cell Carcinoma (SCC), and Basal Cell Carcinoma (BCC) according to Canadian guidelines?

Canadian Guidelines for Follow-Up of Melanoma, SCC, and BCC

The recommended follow-up schedules for melanoma, SCC, and BCC according to Canadian guidelines include stage-specific monitoring with regular skin examinations, self-examination education, and selective imaging based on risk stratification.

Melanoma Follow-Up Guidelines

Stage 0 (In Situ) Melanoma

• H&P with emphasis on nodes and skin every 3-12 months for 5 years, then annually as clinically indicated 1
• At least annual skin examination for life 1, 2
• Patient education on monthly self-skin examination 1
• Routine radiologic imaging not recommended 1

Stage IA-IIA Melanoma (No Evidence of Disease)

• H&P with emphasis on nodes and skin every 3-6 months for 2 years, then every 3-12 months for 3 years, then annually as clinically indicated 1
• At least annual skin examination for life 1
• Educate patient in monthly self-skin and lymph node examination 1, 2
• Routine radiologic imaging to screen for asymptomatic recurrent/metastatic disease is not recommended 1

Stage IIB-IV Melanoma (No Evidence of Disease)

• H&P with emphasis on nodes and skin every 3-6 months for 2 years, then every 3-12 months for 3 years, then annually as clinically indicated 1
• Consider chest x-ray, CT and/or PET/CT scans every 6-12 months to screen for recurrent/metastatic disease (category 2B) 1
• Consider brain MRI annually (category 2B) 1
• Routine radiologic imaging not recommended after 5 years 1
• At least annual skin examination for life 1
• Educate patient in monthly self-skin and lymph node examination 1, 2

Common Follow-Up Recommendations for All Melanoma Patients

• At least annual skin exam for life 1, 2
• Educate patient in monthly self-skin exam (and monthly self lymph node exam for stage IA-IV NED) 1
• Routine blood tests are not recommended 1, 3
• Radiologic imaging is indicated to investigate specific signs or symptoms 1

Basal Cell Carcinoma (BCC) Follow-Up

• Annual skin cancer screening for all patients with a history of BCC 2
• More frequent examinations (every 6-12 months) during the first 2 years post-treatment when risk of recurrence is highest 2
• Counsel patients on skin self-examination techniques and sun protection strategies 2
• Important to note that BCC patients have a 40.7% 5-year probability and 59.6% 10-year probability of developing another non-melanoma skin cancer 2
• BCC patients have increased risk of developing melanoma (relative risk 1.99 for men, 2.58 for women) 2

Squamous Cell Carcinoma (SCC) Follow-Up

• Follow-up for 5 years is recommended, as 95% of local recurrences and metastases are detected within this timeframe 4
• Regular skin examinations with frequency based on risk factors 2, 4
• Patient education on self-examination and sun protection 2, 4

Important Considerations for All Skin Cancer Follow-Up

Risk-Based Approach

• Follow-up schedule should be influenced by risk of recurrence, prior primary skin cancer, family history, and other factors such as atypical moles/dysplastic nevi and patient anxiety 1, 2
• More intensive follow-up is warranted for higher-risk patients 2, 5

Self-Examination Education

• Educate all patients on monthly self-examination of skin 1, 2
• For melanoma patients, include education on lymph node self-examination 1
• Two-thirds of melanoma recurrences are detected by patients themselves or are symptomatic 6

Imaging Considerations

• Routine imaging is not recommended for low-risk patients 1, 6
• For higher-risk melanoma patients (stage IIB and above), consider selective imaging 1
• Imaging studies should be performed as clinically indicated when there are specific signs or symptoms 1, 2

Common Pitfalls to Avoid

• Inconsistent follow-up during the first 1-2 years when risk of recurrence is highest 2
• Relying solely on imaging studies without thorough clinical examination 6, 3
• Failing to educate patients about self-examination techniques 2
• Underestimating the importance of regular skin examinations 2

Evidence-Based Rationale

• Studies show that most melanoma recurrences occur within the first 2-3 years after diagnosis 7, 5
• Physical examination of asymptomatic patients leads to the diagnosis of recurrent disease in approximately 26% of cases 3
• Laboratory results are rarely the sole indicator of recurrent disease 3
• More efficient follow-up strategies with fewer visits but focused approach may be as effective as more intensive monitoring 5