‘Simple model’ helps identify melanoma recurrence

Key takeaways:

• Appetite change, tiredness, lymph node enlargement, abdominal pain and shortness of breath were common with melanoma recurrence.
• Researchers suggest using the acronym ATLAS to evaluate these symptoms.

A “simple model” known as ATLAS can help physicians detect recurrent cutaneous melanoma through symptom review, according to researchers.

“Although the incidence of cutaneous melanoma (CM) has increased over recent decades, advancements in systemic treatments, including both targeted therapies and immune checkpoint inhibitors, have improved overall survival and stabilized mortality,” Emily Everdell, MD, of the Wellman Center for Photomedicine at Massachusetts General Hospital, and colleagues wrote. “Current guidelines for the surveillance of patients with a history of CM, as detailed by both the National Comprehensive Cancer Network and the American Joint Committee on Cancer, are vague regarding frequency and intensity of follow-up visits as well as appropriate diagnostic strategies to optimize detection of recurrence while also considering cost-efficiency and morbidity related to false-positive screenings.”

The researchers conducted a retrospective study of data from 281 patients at one melanoma center who had a history of CM stage 0 to IIIB diagnosed in 2010 or later and received treatment between June 2015 and December 2017.

Of these, 189 developed recurrent disease, whereas 92 did not.

Symptoms in certain clustered organ systems were found to occur more frequently in those who had recurrent disease.

Using a logistic regression model adjusted for age and gender, the researchers calculated positive predictive values (PPV) for each of these organ clusters.

They reported that PPV was 82.54% for appetite loss, fatigue or weight loss; 93.1% for dyspnea on exertion, shortness of breath or cough; and 86.96% for abdominal pain, constipation, diarrhea, nausea or vomiting.

“We identified five symptoms that were significantly associated with disease recurrence — Appetite loss/change, Tiredness/fatigue, Lymph node enlargement, Abdominal pain, and Shortness of breath. We propose a short mnemonic, ATLAS, to help remember these features,” the authors wrote. “While additional evidence from high-quality research is required to validate this simple model, it is reasonable for providers to adopt this concise, yet impactful, [Review of Systems] in their existing CM surveillance practices as it may offer improved detection without adding any recognized risk.”