Clinical Summary

Patients with early-stage disease typically have a good prognosis, but still have a risk of recurrence, even with negative sentinel lymph node biopsy (SLNB). Routine imaging can effectively detect early relapse when there is a lower tumor burden. For patients with stage IIB disease or greater, the National Comprehensive Cancer Network^® (NCCN^®)  recommends chest radiography, CT, brain magnetic resonance imaging, and positron emission tomography and CT every 3–12 months for 3 years at the discretion of the physician. However, routine imaging is not a standard protocol for clinical stage 1 and 2 patients, and the guidelines for surveillance remain controversial.

This study explores the utility of routine imaging to detect metastases in patients with negative SLNB but high-risk 31 gene expression profile (31-GEP) scores.

SLNB negative patients with high-risk GEP results (Class 2A/2B) were placed in the experimental group and SLNB negative patients without GEP testing were placed in the control group. Among both cohorts, recurrent melanoma groups were identified. The tumor burden at the time of recurrence, treatment outcomes, and survival outcomes were all measured and compared between patient groups.

• The average tumor burden among recurrent melanoma patients in the experimental group was 27.60 mm compared to 73.10 mm in recurrent melanoma patients from the control group.
• Melanoma recurrence was detected an average of 9.85 months earlier with the experimental high-risk group average detection at 25.50 months versus 35.35 months for the control group.
• Patients with high-risk 31-GEP results who received routine imaging also showed a statistically significant improved overall survival 76.3% versus 50.0%, p-value= 0.027.