Melanoma Surveillance Imaging — SCE Dermatology MCQ

Correct answer: A — CT or PET-CT at regular intervals as per local guidelines for the first 5 years

The correct answer is A, CT or PET-CT at regular intervals as per local guidelines for the first 5 years. NICE NG14 recommends that patients with resected stage IIC to III melanoma undergo periodic cross-sectional imaging surveillance because their risk of nodal, in-transit, and distant recurrence is high enough to justify early detection, particularly now that effective adjuvant and systemic therapies (immunotherapy, targeted therapy) exist for early relapse. Imaging is typically undertaken at 3 to 6 monthly intervals for the first 2 to 3 years, tapering to 6 monthly for years 4 to 5, with the exact modality (CT versus PET-CT) and schedule left to local protocol rather than a single mandated national regimen. This contrasts with lower-stage disease (IA to IIB), where clinical examination alone is considered sufficient and routine imaging is not recommended, reflecting a much lower recurrence risk. Why the other options are wrong: D. MRI brain only: Isolated brain MRI does not screen for the commonest sites of stage III relapse (regional nodes, in-transit skin, lung, liver) and is reserved for suspected CNS symptoms or as an adjunct, not the primary surveillance tool. B. Bone scan only: Bone is an uncommon first site of melanoma recurrence, so bone scintigraphy alone would miss the great majority of relapses and is not part of routine surveillance. E. Annual chest X-ray only: Plain chest radiography has poor sensitivity for small pulmonary or nodal metastases compared with CT, and annual frequency is too infrequent for high-risk stage III disease. C. No imaging, clinical examination only: This applies to low-risk stage I to IIB disease; stage III recurrence risk is high enough that clinical examination alone would delay detection of treatable relapse. Key point: Stage IIC to III melanoma warrants scheduled CT or PET-CT surveillance for up to 5 years post-treatment, whereas stage IA to IIB relies on clinical examination alone.

Reference: NICE Guideline NG14, Melanoma: assessment and management, Recommendations on follow-up after treatment for melanoma, updated 2022, www.nice.org.uk/guidance/ng14