From the Research
Melanoma that has been fully excised and medically cleared from further disease is referred to as "melanoma in remission" or "no evidence of disease" (NED). After complete surgical excision with clear margins, a patient may be considered disease-free, though regular follow-up is essential as recurrence remains possible. The term "cured" is generally avoided in melanoma care since there's always a risk of recurrence, particularly in the first 2-5 years after treatment. Instead, oncologists typically describe patients as having "no evidence of disease" or being "disease-free" at the current time. The likelihood of remaining disease-free depends on several factors including the original melanoma's stage, depth (Breslow thickness), presence of ulceration, mitotic rate, and whether there was lymph node involvement. Follow-up typically includes regular skin examinations, imaging studies for higher-stage disease, and sometimes blood tests, with the frequency decreasing over time if no recurrence is detected.
Some key points to consider in the management and follow-up of patients with fully excised melanoma include:
- The risk of late metastasis, even after 25 years, as reported in a case study 1
- The importance of adequate clearance margins in wide local excision specimens to minimize the risk of residual disease 2
- The role of adjuvant therapies, such as pembrolizumab, in reducing the risk of recurrence in high-risk patients 3, 4, 5
- The need for ongoing surveillance and follow-up to detect any potential recurrence early, as the risk of recurrence remains even after complete excision and adjuvant therapy.
It's also important to note that while adjuvant therapies like pembrolizumab have shown efficacy in reducing recurrence risk, the decision to use these therapies should be individualized based on the patient's specific risk factors and overall health status, as discussed in studies such as 3 and 5. Regular follow-up and monitoring for signs of recurrence are crucial for all patients, regardless of whether they receive adjuvant therapy.