Metastatic disease in patients with newly diagnosed malignant melanoma

In patients with stage I Clark's level III and IV malignant melanoma (MM), recurrence rates of 30-60% can be expected after resection of the primary lesion. If metastatic disease could be detected early and treated in such patients, survival might be prolonged. Ninety patients (37 males and 53 females) with newly diagnosed, resected stage I cutaneous MM, levels III and IV, were evaluated for metastatic disease at diagnosis using a physical examination; CBC; SMA 18; chest films; brain computed tomography (CT) scan; and radioisotope liver, spleen, and bone scans. Forty-four patients had level III and 46 had level IV melanomas ranging in thickness from 0.65 to 4.5 mm. None of these 90 patients was found to have metastatic disease. Such tests are not useful and can be replaced by a history and physical examination with substantially improved cost effectiveness.