Does staging computered tomography change management in thick malignant melanoma?

Area of Science:

• Oncology
• Radiology
• Dermatology

Background:

• Accurate staging of Malignant Melanoma (MM) is crucial for treatment planning.
• Current UK guidelines recommend Computed Tomography (CT) for staging high-risk MM (AJCC IIB or worse).
• The utility of routine CT staging, including head and neck imaging, is under investigation.

Purpose of the Study:

• To evaluate if CT staging alters clinical management in Malignant Melanoma (MM) patients.
• To assess the benefit of including CT head and neck in the staging protocol for MM.

Main Methods:

• Retrospective review of 132 patient case notes with AJCC IIB or worse melanoma over six years.
• Analysis of CT staging changes in clinical management at initial presentation and follow-up.
• Recording of metastatic disease in various body regions.

Main Results:

• Initial CT staging identified metastatic disease in only 0.7% of patients, with no change in management.
• Follow-up CT scans detected metastases in 8.6% of symptomatic patients, leading to management changes.
• Head metastases were as common as chest/abdomen metastases, but neck CT did not alter management.

Conclusions:

• Routine CT staging for cutaneous melanoma is not indicated without signs or symptoms of metastatic disease.
• Symptomatic patients with AJCC IIB/C melanoma benefit from CT staging.
• Recommended staging for AJCC IIB/C melanoma includes head imaging in addition to chest, abdomen, and pelvis.