Whole-body magnetic resonance imaging for cutaneous melanoma staging: A scientific review

Cutaneous melanoma is an aggressive skin cancer with high metastatic potential. Accurate staging is critical to guide therapeutic strategies and improve prognosis. Whole-body magnetic resonance imaging (WB-MRI), particularly when combined with diffusion-weighted imaging (DWI), has emerged as promising tool for comprehensive, radiation-free assessment of metastatic spread.

To systematically review the diagnostic performance and clinical utility of WB-MRI in the staging and restaging of cutaneous melanoma, with comparison to conventional imaging modalities such as computed tomography (CT) and positron emission tomography/CT (PET/CT).

A systematic literature review was conducted using PubMed, Embase, Scopus and Web of Science databases for studies published in the last 10 years. Inclusion criteria focused on comparative diagnostic accuracy studies of WB-MRI vs CT and PET/CT for melanoma staging. The methodological quality of the studies was appraised using the QUADAS-2 tool.

Sixteen studies involving over 700 patients met the inclusion criteria. WB-MRI showed high sensitivity (73%-90%) and specificity (up to 98%) in detecting metastases, particularly in bone, liver and soft tissue. DWI enhanced lesion detection, and WB-MRI often influenced clinical management decisions. However, CT outperformed WB-MRI in identifying small pulmonary nodules. AI-assisted analysis and contrast-enhanced sequences further improved diagnostic confidence.

WB-MRI represents a robust imaging modality for staging cutaneous melanoma, offering superior soft-tissue contrast and functional imaging without ionizing radiation. Its strengths lie in detecting bone, liver and brain metastases. Challenges include limited lung lesion detection, cost, and availability. Advances in artificial intelligence, Hybrid PET/MRY systems, and radiomics are poised to expand WB-MRI's role in personalized melanoma management.