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The Impact of staging on treatment, prognosis & follow-up
PhD ceremony:drs. E.A. Deckers
When:October 26, 2020
Supervisor:prof. H.J. Hoekstra
Co-supervisors:dr. J.E.H.M. Hoekstra-Weebers, dr. S. (Schelto) Kruijff
Where:Academy building RUG
Faculty:Medical Sciences / UMCG

The incidence of melanoma is still increasing in the Netherlands. The diagnosis of melanoma is made at an increasingly earlier stage of the disease, resulting in a more favorable prognosis. Currently, the 5-year survival rate for melanoma is 92%.

Improving melanoma diagnostics, treatment and follow-up can further increase this percentage. PhD student Eric Deckers therefore conducted research, specifically into the sentinel node procedure, the use of tumor markers and nuclear imaging, the frequency of follow-up and the effect of obesity on disease progression and survival in melanoma.

With the aid of the sentinel node procedure, the presence or absence of metastases in the lymph node (s) can be determined in a minimally invasive manner, so that the correct melanoma treatment can be performed: surgery and / or systemic treatment. The sentinel node procedure is currently only performed at 65% for eligible patients in the Netherlands. A further implementation of this procedure up to 80%, such as with breast cancer, seems necessary.

In the follow-up checks of high-risk melanoma patients without complaints, increased blood levels of the tumor markers S-100B and LDH may be an indication for performing a PET / CT scan to detect early metastases and initiate treatment.

Patients are currently frequently monitored during the first five years after melanoma diagnosis, according to the recommendations in the current guideline. A randomized controlled study showed that a less frequent follow-up than that recommended in the current guideline for sentinel node biopsy staged melanoma patients three years after diagnosis is associated with fewer stress symptoms, comparable anxiety and quality of life. The less frequent follow-up is safe in the sense of detecting recurrences and survival and it reduces the costs of follow-up by 39%.

Obesity does not yet seem to be associated with recurrence-free and overall survival. A multi-center study, so that more patients can be involved in the study, is needed to confirm or invalidate this result.

The improvements in melanoma diagnostics with the sentinel lymph node biopsy, tumor markers, PET / CT and stage-based follow-up schedules contribute to better, cost-effective melanoma treatment and quality of life.