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Use of chest radiography in the initial evaluation of patients with localized melanoma
M H Terhune1, N Swanson, T M Johnson
1Department of Dermatology, University of Michigan Medical Center, Ann Arbor, USA.
Objective:
To evaluate the use of an initial staging chest x-ray film in asymptomatic patients who present with localized primary cutaneous melanoma.
Design:
The staging workup of 1032 consecutive asymptomatic patients with localized melanoma was retrospectively reviewed via database chart review.
Setting:
Regional melanoma referral center in an academic medical center.
Patients:
The melanoma database identified 1032 asymptomatic patients with localized melanoma for retrospective review. Of the patients studied, 876 (85%) of 1032 had an initial staging chest x-ray film performed. A chest x-ray film was considered initial if performed within 6 months of melanoma diagnosis.
Main Outcome Measure:
The rate of positive, negative, and suspicious findings of initial chest x-ray films.
Results:
One hundred thirty (15%) of 876 patients had suspicious findings necessitating additional workup. Based on follow-up radiologic findings, only 1 (0.1%) of 876 had a true-positive chest x-ray film demonstrating pulmonary metastasis.
Conclusions:
The yield of detection of unsuspected pulmonary metastasis by chest x-ray film in the initial evaluation of asymptomatic patients with localized melanoma was exceedingly low (0.1%). Our results support the concept that routine chest radiograph screening in asymptomatic patients presenting with stage I and intermediate-thickness (1.5- to 4.0-mm) stage II melanoma is unlikely to yield true-positive findings of silent pulmonary metastasis. No definitive conclusions were drawn for the subset of patients with stage II thick melanoma (> 4.0 mm) because of the small number of patients (n = 40) in our series. Prospective studies are necessary to ultimately define the yield of initial radiographs in asymptomatic patients with localized melanoma.