Cost-effectiveness of surveillance of stage I melanoma. A retrospective appraisal based on a 10-year experience in a dermatology department in France.
Identifieur interne : 001149 ( Main/Exploration ); précédent : 001148; suivant : 001150Cost-effectiveness of surveillance of stage I melanoma. A retrospective appraisal based on a 10-year experience in a dermatology department in France.
Auteurs : N. Bassères [France] ; J J Grob ; M A Richard ; X. Thirion ; H. Zarour ; C. Noe ; A M Collet-Vilette ; I. Lota ; J J BonerandiSource :
- Dermatology (Basel, Switzerland) [ 1018-8665 ] ; 1995.
Descripteurs français
- KwdFr :
- Analyse coût-bénéfice (MeSH), Facteurs de risque (MeSH), Femelle (MeSH), France (MeSH), Humains (MeSH), Mâle (MeSH), Mélanome (), Mélanome (prévention et contrôle), Mélanome (secondaire), Mélanome (économie), Métastase lymphatique (anatomopathologie), Métastase lymphatique (prévention et contrôle), Radiographie thoracique (économie), Récidive tumorale locale (), Récidive tumorale locale (prévention et contrôle), Récidive tumorale locale (économie), Stadification tumorale (MeSH), Surveillance de la population (MeSH), Tomodensitométrie (économie), Tumeurs cutanées (), Tumeurs cutanées (prévention et contrôle), Tumeurs cutanées (économie), Échographie (économie), Études de suivi (MeSH), Études rétrospectives (MeSH).
- MESH :
- anatomopathologie : Métastase lymphatique.
- prévention et contrôle : Mélanome, Métastase lymphatique, Récidive tumorale locale, Tumeurs cutanées.
- secondaire : Mélanome.
- économie : Mélanome, Radiographie thoracique, Récidive tumorale locale, Tomodensitométrie, Tumeurs cutanées, Échographie.
- Analyse coût-bénéfice, Facteurs de risque, Femelle, France, Humains, Mâle, Mélanome, Récidive tumorale locale, Stadification tumorale, Surveillance de la population, Tumeurs cutanées, Études de suivi, Études rétrospectives.
- Wicri :
- geographic : France.
English descriptors
- KwdEn :
- Cost-Benefit Analysis (MeSH), Female (MeSH), Follow-Up Studies (MeSH), France (MeSH), Humans (MeSH), Lymphatic Metastasis (pathology), Lymphatic Metastasis (prevention & control), Male (MeSH), Melanoma (economics), Melanoma (prevention & control), Melanoma (radiography), Melanoma (secondary), Melanoma (ultrasonography), Neoplasm Recurrence, Local (economics), Neoplasm Recurrence, Local (prevention & control), Neoplasm Recurrence, Local (radiography), Neoplasm Recurrence, Local (ultrasonography), Neoplasm Staging (MeSH), Population Surveillance (MeSH), Radiography, Thoracic (economics), Retrospective Studies (MeSH), Risk Factors (MeSH), Skin Neoplasms (economics), Skin Neoplasms (prevention & control), Skin Neoplasms (radiography), Skin Neoplasms (ultrasonography), Tomography, X-Ray Computed (economics), Ultrasonography (economics).
- MESH :
- geographic : France.
- economics : Melanoma, Neoplasm Recurrence, Local, Radiography, Thoracic, Skin Neoplasms, Tomography, X-Ray Computed, Ultrasonography.
- pathology : Lymphatic Metastasis.
- prevention & control : Lymphatic Metastasis, Melanoma, Neoplasm Recurrence, Local, Skin Neoplasms.
- radiography : Melanoma, Neoplasm Recurrence, Local, Skin Neoplasms.
- secondary : Melanoma.
- ultrasonography : Melanoma, Neoplasm Recurrence, Local, Skin Neoplasms.
- Cost-Benefit Analysis, Female, Follow-Up Studies, Humans, Male, Neoplasm Staging, Population Surveillance, Retrospective Studies, Risk Factors.
Abstract
BACKGROUND
There is no agreement about surveillance after resection of a stage I melanoma.
OBJECTIVE
We assessed the cost-effectiveness of this surveillance.
METHODS
Out of 912 patients with stage I (and Clark's level > or = II) melanoma examined from 1981 to 1991, only 528 were regularly followed in our department.
RESULTS
115 out of 528 relapsed; 33% were detected by the patient himself, 16% by the referring physician and 39% were detected in our department. Chest X-ray or abdomen ultrasonography revealed only 10% of relapses; CT scans were useless. There was a huge gap between the cost-effectiveness of clinical examinations and radiology. The time between relapse and the last check-up in our department was less than 4 months in one third of the metastases.
CONCLUSIONS
In stage I melanoma, only clinical examination is really cost-effective in the detection of metastases. However, many metastases are likely to become prominent between two examinations if patients are examined less than 3 times a year. A progressive decrease in frequency is thus not advisable, until the risk is considered low enough to stop follow-up.
PubMed: 8534937
Affiliations:
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Bassères</name><affiliation wicri:level="3"><nlm:affiliation>Laboratoire d'Investigations sur les Maladies de la Peau, Hôpital Ste-Marguerite, Marseille, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Laboratoire d'Investigations sur les Maladies de la Peau, Hôpital Ste-Marguerite, Marseille</wicri:regionArea><placeName><region type="region">Provence-Alpes-Côte d'Azur</region><region type="old region">Provence-Alpes-Côte d'Azur</region><settlement type="city">Marseille</settlement></placeName></affiliation></author><author><name sortKey="Grob, J J" sort="Grob, J J" uniqKey="Grob J" first="J J" last="Grob">J J Grob</name></author><author><name sortKey="Richard, M A" sort="Richard, M A" uniqKey="Richard M" first="M A" last="Richard">M A Richard</name></author><author><name sortKey="Thirion, X" sort="Thirion, X" uniqKey="Thirion X" first="X" last="Thirion">X. Thirion</name></author><author><name sortKey="Zarour, H" sort="Zarour, H" uniqKey="Zarour H" first="H" last="Zarour">H. Zarour</name></author><author><name sortKey="Noe, C" sort="Noe, C" uniqKey="Noe C" first="C" last="Noe">C. Noe</name></author><author><name sortKey="Collet Vilette, A M" sort="Collet Vilette, A M" uniqKey="Collet Vilette A" first="A M" last="Collet-Vilette">A M Collet-Vilette</name></author><author><name sortKey="Lota, I" sort="Lota, I" uniqKey="Lota I" first="I" last="Lota">I. Lota</name></author><author><name sortKey="Bonerandi, J J" sort="Bonerandi, J J" uniqKey="Bonerandi J" first="J J" last="Bonerandi">J J Bonerandi</name></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="1995">1995</date><idno type="RBID">pubmed:8534937</idno><idno type="pmid">8534937</idno><idno type="wicri:Area/PubMed/Corpus">000162</idno><idno type="wicri:explorRef" wicri:stream="PubMed" wicri:step="Corpus" wicri:corpus="PubMed">000162</idno><idno type="wicri:Area/PubMed/Curation">000162</idno><idno type="wicri:explorRef" wicri:stream="PubMed" wicri:step="Curation">000162</idno><idno type="wicri:Area/PubMed/Checkpoint">000162</idno><idno type="wicri:explorRef" wicri:stream="Checkpoint" wicri:step="PubMed">000162</idno><idno type="wicri:Area/Ncbi/Merge">000483</idno><idno type="wicri:Area/Ncbi/Curation">000483</idno><idno type="wicri:Area/Ncbi/Checkpoint">000483</idno><idno type="wicri:doubleKey">1018-8665:1995:Basseres N:cost:effectiveness:of</idno><idno type="wicri:Area/Main/Merge">001219</idno><idno type="wicri:Area/Main/Curation">001149</idno><idno type="wicri:Area/Main/Exploration">001149</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">Cost-effectiveness of surveillance of stage I melanoma. A retrospective appraisal based on a 10-year experience in a dermatology department in France.</title><author><name sortKey="Basseres, N" sort="Basseres, N" uniqKey="Basseres N" first="N" last="Bassères">N. Bassères</name><affiliation wicri:level="3"><nlm:affiliation>Laboratoire d'Investigations sur les Maladies de la Peau, Hôpital Ste-Marguerite, Marseille, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Laboratoire d'Investigations sur les Maladies de la Peau, Hôpital Ste-Marguerite, Marseille</wicri:regionArea><placeName><region type="region">Provence-Alpes-Côte d'Azur</region><region type="old region">Provence-Alpes-Côte d'Azur</region><settlement type="city">Marseille</settlement></placeName></affiliation></author><author><name sortKey="Grob, J J" sort="Grob, J J" uniqKey="Grob J" first="J J" last="Grob">J J Grob</name></author><author><name sortKey="Richard, M A" sort="Richard, M A" uniqKey="Richard M" first="M A" last="Richard">M A Richard</name></author><author><name sortKey="Thirion, X" sort="Thirion, X" uniqKey="Thirion X" first="X" last="Thirion">X. Thirion</name></author><author><name sortKey="Zarour, H" sort="Zarour, H" uniqKey="Zarour H" first="H" last="Zarour">H. Zarour</name></author><author><name sortKey="Noe, C" sort="Noe, C" uniqKey="Noe C" first="C" last="Noe">C. Noe</name></author><author><name sortKey="Collet Vilette, A M" sort="Collet Vilette, A M" uniqKey="Collet Vilette A" first="A M" last="Collet-Vilette">A M Collet-Vilette</name></author><author><name sortKey="Lota, I" sort="Lota, I" uniqKey="Lota I" first="I" last="Lota">I. Lota</name></author><author><name sortKey="Bonerandi, J J" sort="Bonerandi, J J" uniqKey="Bonerandi J" first="J J" last="Bonerandi">J J Bonerandi</name></author></analytic><series><title level="j">Dermatology (Basel, Switzerland)</title><idno type="ISSN">1018-8665</idno><imprint><date when="1995" type="published">1995</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Cost-Benefit Analysis (MeSH)</term><term>Female (MeSH)</term><term>Follow-Up Studies (MeSH)</term><term>France (MeSH)</term><term>Humans (MeSH)</term><term>Lymphatic Metastasis (pathology)</term><term>Lymphatic Metastasis (prevention & control)</term><term>Male (MeSH)</term><term>Melanoma (economics)</term><term>Melanoma (prevention & control)</term><term>Melanoma (radiography)</term><term>Melanoma (secondary)</term><term>Melanoma (ultrasonography)</term><term>Neoplasm Recurrence, Local (economics)</term><term>Neoplasm Recurrence, Local (prevention & control)</term><term>Neoplasm Recurrence, Local (radiography)</term><term>Neoplasm Recurrence, Local (ultrasonography)</term><term>Neoplasm Staging (MeSH)</term><term>Population Surveillance (MeSH)</term><term>Radiography, Thoracic (economics)</term><term>Retrospective Studies (MeSH)</term><term>Risk Factors (MeSH)</term><term>Skin Neoplasms (economics)</term><term>Skin Neoplasms (prevention & control)</term><term>Skin Neoplasms (radiography)</term><term>Skin Neoplasms (ultrasonography)</term><term>Tomography, X-Ray Computed (economics)</term><term>Ultrasonography (economics)</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Analyse coût-bénéfice (MeSH)</term><term>Facteurs de risque (MeSH)</term><term>Femelle (MeSH)</term><term>France (MeSH)</term><term>Humains (MeSH)</term><term>Mâle (MeSH)</term><term>Mélanome ()</term><term>Mélanome (prévention et contrôle)</term><term>Mélanome (secondaire)</term><term>Mélanome (économie)</term><term>Métastase lymphatique (anatomopathologie)</term><term>Métastase lymphatique (prévention et contrôle)</term><term>Radiographie thoracique (économie)</term><term>Récidive tumorale locale ()</term><term>Récidive tumorale locale (prévention et contrôle)</term><term>Récidive tumorale locale (économie)</term><term>Stadification tumorale (MeSH)</term><term>Surveillance de la population (MeSH)</term><term>Tomodensitométrie (économie)</term><term>Tumeurs cutanées ()</term><term>Tumeurs cutanées (prévention et contrôle)</term><term>Tumeurs cutanées (économie)</term><term>Échographie (économie)</term><term>Études de suivi (MeSH)</term><term>Études rétrospectives (MeSH)</term></keywords><keywords scheme="MESH" type="geographic" xml:lang="en"><term>France</term></keywords><keywords scheme="MESH" qualifier="anatomopathologie" xml:lang="fr"><term>Métastase lymphatique</term></keywords><keywords scheme="MESH" qualifier="economics" xml:lang="en"><term>Melanoma</term><term>Neoplasm Recurrence, Local</term><term>Radiography, Thoracic</term><term>Skin Neoplasms</term><term>Tomography, X-Ray Computed</term><term>Ultrasonography</term></keywords><keywords scheme="MESH" qualifier="pathology" xml:lang="en"><term>Lymphatic Metastasis</term></keywords><keywords scheme="MESH" qualifier="prevention & control" xml:lang="en"><term>Lymphatic Metastasis</term><term>Melanoma</term><term>Neoplasm Recurrence, Local</term><term>Skin Neoplasms</term></keywords><keywords scheme="MESH" qualifier="prévention et contrôle" xml:lang="fr"><term>Mélanome</term><term>Métastase lymphatique</term><term>Récidive tumorale locale</term><term>Tumeurs cutanées</term></keywords><keywords scheme="MESH" qualifier="radiography" xml:lang="en"><term>Melanoma</term><term>Neoplasm Recurrence, Local</term><term>Skin Neoplasms</term></keywords><keywords scheme="MESH" qualifier="secondaire" xml:lang="fr"><term>Mélanome</term></keywords><keywords scheme="MESH" qualifier="secondary" xml:lang="en"><term>Melanoma</term></keywords><keywords scheme="MESH" qualifier="ultrasonography" xml:lang="en"><term>Melanoma</term><term>Neoplasm Recurrence, Local</term><term>Skin Neoplasms</term></keywords><keywords scheme="MESH" qualifier="économie" xml:lang="fr"><term>Mélanome</term><term>Radiographie thoracique</term><term>Récidive tumorale locale</term><term>Tomodensitométrie</term><term>Tumeurs cutanées</term><term>Échographie</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Cost-Benefit Analysis</term><term>Female</term><term>Follow-Up Studies</term><term>Humans</term><term>Male</term><term>Neoplasm Staging</term><term>Population Surveillance</term><term>Retrospective Studies</term><term>Risk Factors</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Analyse coût-bénéfice</term><term>Facteurs de risque</term><term>Femelle</term><term>France</term><term>Humains</term><term>Mâle</term><term>Mélanome</term><term>Récidive tumorale locale</term><term>Stadification tumorale</term><term>Surveillance de la population</term><term>Tumeurs cutanées</term><term>Études de suivi</term><term>Études rétrospectives</term></keywords><keywords scheme="Wicri" type="geographic" xml:lang="fr"><term>France</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><b>BACKGROUND</b></p><p>There is no agreement about surveillance after resection of a stage I melanoma.</p></div><div type="abstract" xml:lang="en"><p><b>OBJECTIVE</b></p><p>We assessed the cost-effectiveness of this surveillance.</p></div><div type="abstract" xml:lang="en"><p><b>METHODS</b></p><p>Out of 912 patients with stage I (and Clark's level > or = II) melanoma examined from 1981 to 1991, only 528 were regularly followed in our department.</p></div><div type="abstract" xml:lang="en"><p><b>RESULTS</b></p><p>115 out of 528 relapsed; 33% were detected by the patient himself, 16% by the referring physician and 39% were detected in our department. Chest X-ray or abdomen ultrasonography revealed only 10% of relapses; CT scans were useless. There was a huge gap between the cost-effectiveness of clinical examinations and radiology. The time between relapse and the last check-up in our department was less than 4 months in one third of the metastases.</p></div><div type="abstract" xml:lang="en"><p><b>CONCLUSIONS</b></p><p>In stage I melanoma, only clinical examination is really cost-effective in the detection of metastases. However, many metastases are likely to become prominent between two examinations if patients are examined less than 3 times a year. A progressive decrease in frequency is thus not advisable, until the risk is considered low enough to stop follow-up.</p></div></front></TEI><affiliations><list><country><li>France</li></country><region><li>Provence-Alpes-Côte d'Azur</li></region><settlement><li>Marseille</li></settlement></list><tree><noCountry><name sortKey="Bonerandi, J J" sort="Bonerandi, J J" uniqKey="Bonerandi J" first="J J" last="Bonerandi">J J Bonerandi</name><name sortKey="Collet Vilette, A M" sort="Collet Vilette, A M" uniqKey="Collet Vilette A" first="A M" last="Collet-Vilette">A M Collet-Vilette</name><name sortKey="Grob, J J" sort="Grob, J J" uniqKey="Grob J" first="J J" last="Grob">J J Grob</name><name sortKey="Lota, I" sort="Lota, I" uniqKey="Lota I" first="I" last="Lota">I. Lota</name><name sortKey="Noe, C" sort="Noe, C" uniqKey="Noe C" first="C" last="Noe">C. Noe</name><name sortKey="Richard, M A" sort="Richard, M A" uniqKey="Richard M" first="M A" last="Richard">M A Richard</name><name sortKey="Thirion, X" sort="Thirion, X" uniqKey="Thirion X" first="X" last="Thirion">X. Thirion</name><name sortKey="Zarour, H" sort="Zarour, H" uniqKey="Zarour H" first="H" last="Zarour">H. Zarour</name></noCountry><country name="France"><region name="Provence-Alpes-Côte d'Azur"><name sortKey="Basseres, N" sort="Basseres, N" uniqKey="Basseres N" first="N" last="Bassères">N. Bassères</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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