Evaluation of outpatient discharge in patients with cutaneous
               melanoma

we conducted an observational, cross-sectional study with 32 patients at the Hospital Universitário Clementino Fraga Filho (HUCFF) / Universidade Federal do Rio de Janeiro (UFRJ), between 1995 and 2013, in the following stages: IA (17 cases, 53.12%), IB (4 cases, 12.5%), IIA (3 cases, 9.37%), IIC (1 case, 3.12%), IIIB (1 case, 3.12%), IIIC (3 cases, 9.37%), melanomas in situ (2 cases, 6.25%), Tx (1 case, 3.12%).

RESULTS:

the follow-up time varied from one to 20 years (stage IA), five to 15 years (stage IB), six to 17 years (stage IIA), 20 years (stage IIC), 23 years (stage IIIB) and 14 to 18 years (stage IIIC). One melanoma in situ (subungueal) was discharged in the fourth year of follow-up and the other was promptly discharged. The Tx melanoma was followed for 12 years. We observed no relapses or recurrences in the period.

CONCLUSION:

although a controversial issue, it was possible to endorse the discharge of the patients since our follow-up time had already exceeded the one recommended by the other authors.

Prospective studies; Melanoma; Melanoma/epidemiology; Follow-up studies; Neoplasm staging

Age Group		Gender		C o l o r				Location
		F	M	W	N W	H e a d	T r u n k	U p p e r	Lower	F o o t	H a n d
								L i m b	L i m b

20-30	years old	-	1	1	-	-	1	-	-	-	-
31-40	years old	2	-	1	1	1	1	-	-	-	-
41-50 years old		4	4	7	1	2	3	-	2	-	1
51-60 years old		6	2	6	2	1	2	1	1	3	-
61-70 years old		6	1	7	-	3	1	1	1	1	-
71-80 years old		2	3	5	-	1	2	1	-	1	-
81-90	years old	1	-	1	-	0	1	-	-	-	-
TOTAIS		21	11	28	4	8	11	3	4	5	1



Stage Number		Outpatient	Follow-up	T i m e
of	cases	R o u t i n e

Tx	1	§ not-defined		12 years
Tis	2	§ resection with a 0.5 cm margin		Discharge
		§ discharge		4 years
I A	17	§ Resection: 1.0 cm margin
		§ dermatological and lymph node examination: every six months (first two years)		1,2,4,5,7,10, 12
		and then annually		14,15,16,20 years
I B	4	§ Resection:	2,0 cm margin
		§ Dermatological and lymph node examination: every two months (two years)		5, 5, 11, 15 years
		and thereafter, every six months
		§ X-ray of chest and liver function tests: every six months (two years)
		and then annually
II A	3	I B		6, 15, 17 years
II C	1	§ Resection: 2,0 cm margin
		§ Dermatological and lymph node examination: every two months (two years)
		and thereafter, every six months		20 anos
		§ X-ray of chest and liver function tests: every six months (two years)
		and then annually		20 years
III B	1	§ Clinical examination every four months
		§ X-ray of chest and liver function tests: every six months
		§ Imaging tests targeted to the region where there is relapse		23 years
		every four months
		§ Resection of limited locoregional and visceral metastases
		§ individualized chemotherapy
III C	3	III B		14, 18 years



Stage	Tumor (T)	Lymph nodes (N)	Metastasis (M)

I A	< 1mm	Ø	Ø
	Clark II/III
	without histological ulceration
I B	< 1mm
	Clark IV/V
	with histological ulceration	Ø	Ø
	1,01 – 2 mm
	without histological ulceration
II A	1,01 – 2 mm
	with histological ulceration	Ø	Ø
	2,01 – 4 mm
	without histological ulceration
IIB	2,01 – 4 mm with ulceration	Ø	Ø
	> 4mm without ulceration
II C	> 4mm with histological ulceration	Ø	Ø
IIIA	<1mm a >4mm without ulceration	Ø	Ø
	<1mm a >4mm	1 micrometastasis	Ø
	Without ulceration	1 a 3 micrometastases	Ø
III B	<1mm a >4mm with or without histological	1 a 3 micrometastases	Ø
	ulcerationtransit metastasissatellitosis	2 a 3 macrometastases
III C	<1mm a >4mm	Confluent lymph nodes	Ø
	histological ulcerationany thick	1 macrometastasis
	nesssatellitosistransit metastasis	2 to 3 or more than
		4 macrometastases

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[1] Address for correspondence: Nurimar C. Fernandes E-mail:nurimarfernandes@terra.com.br