Image studies on staging and follow up of the skin melanoma: a retrospective cohort

• Grant number: 17/02305-4
• Support Opportunities: Scholarships in Brazil - Scientific Initiation
• Start date: July 01, 2017
• End date: June 30, 2018
• Field of knowledge: Health Sciences - Medicine
• Principal Investigator: Juliano Vilaverde Schmitt
• Grantee: Luiza Boava Souza
• Host Institution: Faculdade de Medicina (FMB). Universidade Estadual Paulista (UNESP). Campus de Botucatu. Botucatu , SP, Brazil

Abstract

The skin melanoma, a neoplasm originated from melanocytes, represents five percent of skin malignant tumors, but accounts for around 80% of deaths from skin cancer. Its incidence is raising due to an early diagnosis of initials lesions, among other factors. As it has a high metastatic potential, image studies are used to identify other organs commitment. An early and accurate diagnosis increases the odds of a curative surgical excision, being that a suitable cancer staging is important to set out a right treatment strategy and to estimate the prognosis. There is a huge diversity of protocols to execute the tumor staging, with a tendency to individualize the clinical follow-up. Moreover, many unnecessary studies may be done, increasing the costs, the risk for iatrogeny, and the finding of incidentalomas. Despite the majority of protocols point out only to do sentinel lymph node studies for tumors with stages e T1b, extensive image studies have been solicited for even early stages. Regarding these observation, we can realize that there is a necessity to rationalize follow-up protocols, aiming to decrease the public health spendings, the execution of invasive studies and the findings of false positives. Therefore, we intent to evaluate the frequency of image studies done related to tumor staging and follow-up of melanoma patients, trying to establish associations between clinic features of the carrier and the significant findings in the image studies, as well as the true and false positive rates. We also intent to estimate the costs of studies and the rates and features of incidentalomas, besides the risks and adverse events related to these studies. All cases of skin melanoma treated and followed in the clinical hospital of Botucatu Medical School between 1999 and 2016 will be reviewed regarding the image studies and the tumor progress. It is a retrospective cohort study design including all but in situ tumors. The results of imaging studies will be assessed according to the radiological reports. Positivity will be considered true when obtained histological evidence of the tumor, or when the patient's progress manifest clinically evident relapse. Others tumors whose diagnostic investigation was prompted by findings in staging tests and melanoma follow-up will be considered as incidentalomas. Examination costs will be analyzed using values listed in the latest available edition of the Brazilian Hierarchical Classification of Medical Procedures (CBHPM) and unified table of procedure by SUS. With this study, we intend to add new information on the clinical staging and follow-up of melanoma, with a perspective of optimization on health funding. (AU)