Review of Evidence-Based Support for Pretreatment Imaging in Melanoma

View More View Less
  • 1 University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan
  • 2 Journal of the National Comprehensive Cancer Network
View More View Less
  • 1 University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan
  • 2 Journal of the National Comprehensive Cancer Network

When making a new diagnosis of melanoma, clinicians often obtain imaging studies to rule out clinically occult distant disease. These studies range from inexpensive tests, such as chest radiographs, to more expensive studies, such as PET/CT. The impetus for ordering these studies is usually the desire to identify potentially resectable distant disease, avoid surgery when curative resection is not possible, and assuage patient anxiety by showing that no evidence of distant disease is present. However, some detrimental aspects to these studies are less apparent, including cost and potential for false-positive findings. Although routine use seems reasonable, the true benefit of these studies depends on the probability of clinically occult disease being present, likelihood that disease will be detected with the available technology, and impact of earlier detection on outcome. Contrary to current practice patterns, available evidence suggests that preoperative imaging studies are associated with significant costs and minimal benefit in most patients with melanoma. This article reviews available literature on the role of pretreatment imaging in patients with newly diagnosed cutaneous melanoma.

If the inline PDF is not rendering correctly, you can download the PDF file here.

Correspondence to: Michael S. Sabel, MD, University of Michigan Health Systems, 1500 East Medical Center Drive, 3303 Cancer Geriatric Center SPC 5932, Ann Arbor, MI 48109-5932. E-mail: msabel@med.umich.edu

Disclosure: Michael S. Sabel, MD, has disclosed no relevant financial relationships.

Disclosure: Sandra L. Wong, MD, has disclosed no relevant financial relationships.

Disclosure: Kerrin G. Robinson, MA, has disclosed no relevant financial relationships.

  • 1

    Balch CM, Soong SJ, Gershenwald JE. Prognostic factors analysis of 17,600 melanoma patients: validation of the American Joint Committee on Cancer melanoma staging system. J Clin Oncol 2001;19:36223634.

    • Search Google Scholar
    • Export Citation
  • 2

    Coit DG, Andtbacka R, Bichakjian CK. NCCN Clinical Practice Guidelines in Oncology: Melanoma, version 2, 2009. Available at: http://www.nccn.org/professionals/physician_gls/f_ guidelines.asp. Accessed January 12, 2009.

    • Search Google Scholar
    • Export Citation
  • 3

    Sober AJ, Chuang TY, Duvic M. Guideline of care for primary cutaneous melanoma. J Am Acad Dermatol 2001;45:579586.

  • 4

    Roberts DLL, Anstey AV, Barlow RJ. U.K. guidelines for the management of cutaneous melanoma. Br J Dermatol 2003;146:717.

  • 5

    Hofmann U, Szedlak M, Rittgen W. Primary staging and follow-up in melanoma patients: monocenter evaluation of methods, costs and patient survival. Br J Cancer 2002;87:151157.

    • Search Google Scholar
    • Export Citation
  • 6

    Weiss M, Loprinzi CL, Creagan ET. Utility of follow-up tests for detecting recurrent disease in patients with malignant melanomas. JAMA 1995;274:17031705.

    • Search Google Scholar
    • Export Citation
  • 7

    Leiter U, Meier F, Schittek B, Garbe C. The natural course of cutaneous melanoma. J Surg Oncol 2004;86:172178.

  • 8

    Patel JK, Didolkar MS, Pickren JW, Moore RH. Metastatic pattern of malignant melanoma. A study of 216 autopsy cases. Am J Surg 1978;135:807810.

    • Search Google Scholar
    • Export Citation
  • 9

    Khansur T, Sanders J, Das SK. Evaluation of staging workup in malignant melanoma. Arch Surg 1989;124:847849.

  • 10

    Ardizzoni A, Grimaldi A, Repetto L. Stage I-II melanoma: the value of metastatic work-up. Oncology 1987;44:8789.

  • 11

    Zartman GM, Thomas MR, Robinson WA. Metastatic disease in patients with newly diagnosed malignant melanoma. J Surg Oncol 1987;35:163164.

  • 12

    Yancowitz M, Finelt N, Warycha MA. Role of radiologic imaging at the time of initial diagnosis of stage T1b-T3b melanoma. Cancer 2007;110:11071113.

    • Search Google Scholar
    • Export Citation
  • 13

    Hafner J, Schmid MH, Kempf W. Baseline staging in cutaneous malignant melanoma. Br J Dermatol 2004;150:677686.

  • 14

    Wang TS, Johnson TM, Cascade PN. Evaluation of staging chest radiographs and serum lactate dehydrogenase for localized melanoma. J Am Acad Dermatol 2004;51:399405.

    • Search Google Scholar
    • Export Citation
  • 15

    Terhune MH, Swanson N, Johnson TM. Use of chest radiography in the initial evaluation of patients with localized melanoma. Arch Dermatol 1998;134:569572.

    • Search Google Scholar
    • Export Citation
  • 16

    Kanzler MH. Initial evaluation of melanoma (letter to the editor). Arch Dermatol 1999;135:11211122.

  • 17

    Weiss M, Loprinzi CL, Creagan ET. Utility of follow-up tests for detecting recurrent disease in patients with malignant melanoma. JAMA 1995;274:17031705.

    • Search Google Scholar
    • Export Citation
  • 18

    Webb WR, Gamsu G. Thoracic metastasis in malignant melanoma: a radiographic survey of 66 patients. Chest 1977;71:176181.

  • 19

    Chen JT, Dahmash NS, Ravin CE. Metastatic melanoma to the thorax. AJR Am J Roentgenol 1981;137:293298.

  • 20

    Das Gupta T, Brasfield R. Metastatic melanoma. Cancer 1964;17:13231339.

  • 21

    Gross EA. Initial evaluation of melanoma: Don‘t stop getting that chest x-ray....yet. Arch Dermatol 1998; 134:623624.

  • 22

    Parish LC, Witkowski JA. Melanoma and the radiograph: sanctity of human life. Lancet 1998; 352:922923.

  • 23

    Klein M, Freedman N, Lotem M. Contribution of whole body F-18-FDG-PET and lymphoscintigraphy to the assessment of regional and distant metastases in cutaneous malignant melanoma. Nuklearmedizin 2000;39:5661.

    • Search Google Scholar
    • Export Citation
  • 24

    Belhocine T, Pierard G, De Labrassinne M. Staging of regional nodes in AJCC stage I and II melanoma: 18FDG PET imaging versus sentinel node detection. Oncologist 2002;7:271278.

    • Search Google Scholar
    • Export Citation
  • 25

    Fink AM, Holle-Robatsch S, Herzog N. Positron emission tomography is not useful in detecting metastasis in the sentinel lymph node in patients with primary malignant melanoma stage I and II. Melanoma Res 2004;14:141145.

    • Search Google Scholar
    • Export Citation
  • 26

    Longo MI, Lazaro P, Bueno C. Flourodeoxyglucose-positron emission tomography imaging versus sentinel node biopsy in the primary staging of melanoma patients. Dermatol Surg 2003;29:245248.

    • Search Google Scholar
    • Export Citation
  • 27

    Libberecht K, Husada G, Peeters T. Initial staging of malignant melanoma by positron emission tomography and sentinel node biopsy. Acta Chir Belg 2005;105:621625.

    • Search Google Scholar
    • Export Citation
  • 28

    Vereecken P, Laporte M, Petein M. Evaluation of extensive intitial staging procedure in intermediate/high-risk melanoma patients. J Eur Acad Dermatol Venereol 2005;19:6673.

    • Search Google Scholar
    • Export Citation
  • 29

    Clark PB, Soo V, Kraas J. Futility of flourodeoxyglucose F18 positron emission tomography in initial evaluation of patients with T2 to T4 melanoma. Arch Surg 2006;141:284288.

    • Search Google Scholar
    • Export Citation
  • 30

    Kell MR, Ridge JA, Joseph N, Sigurdson ER. PET CT imaging in patients undergoing sentinel node biopsy for melanoma. Eur J Surg Onc 2007;33:911913.

    • Search Google Scholar
    • Export Citation
  • 31

    Essner R, Belhocine T, Scott AM, Even-Sapir E. Novel imaging techniques in melanoma. Surg Oncol Clin N Am 2006;15:253283.

  • 32

    Ho Shon IA, Chung DK, Saw RP, Thompason JF. Imaging in cutaneous melanoma. Nucl Med Commun 2008;29:847876.

  • 33

    Crippa F, Leutner M, Belli F. Which kinds of lymph node metastases can FDG PET detect? A clinical study in melanoma. J Nucl Med 2000;41:14911494.

    • Search Google Scholar
    • Export Citation
  • 34

    Wagner JD, Schauwecker D, Davidson D. Inefficacy of F-18 flourodeoxy-D-glucose-positron emission tomography scans for initial evaluation in early-stage cutaneous melanoma. Cancer 2005;104:570579.

    • Search Google Scholar
    • Export Citation
  • 35

    Alvarez S, Anorbe E, Alcorta P. Role of sonography in the diagnosis of axillary lymph node metastases in breast cancer: a systematic review. AJR Am J Roentgenol 2006;186:13421348.

    • Search Google Scholar
    • Export Citation
  • 36

    Rossi CR, Mocellin S, Scagnet B. The role of preoperative ultrasound scan in detecting lymph node metastasis before sentinel node biopsy in melanoma patients. J Surg Oncol 2003;82:8084.

    • Search Google Scholar
    • Export Citation
  • 37

    Voit C, Kron M, Schafer G. Ultrasound-guided fine needle aspiration cytology prior to sentinel lymph node biopsy in melanoma patients. Ann Surg Oncol 2006;13:16821689.

    • Search Google Scholar
    • Export Citation
  • 38

    Starritt EC, Uren RF, Scolyer RA. Ultrasound examination of sentinel nodes in the initial assessment of patients with primary cutaneous melanoma. Ann Surg Oncol 2005;12:1823.

    • Search Google Scholar
    • Export Citation
  • 39

    Buzaid AC, Sandler AB, Mani S. Role of computed tomography in the staging of primary melanoma. J Clin Oncol 1993;11:638643.

  • 40

    Morton DL, Thompson JF, Cochran AJ. Sentinel-node biopsy or nodal observation in melanoma. N Engl J Med 2006; 355:13071317.

  • 41

    Strobel K, Skalsky J, Kalff V. Tumour assessment in advanced melanoma: value of FDG-PET/CT in patients with elevated serum S-100B. Eur J Nucl Med Mol Imaging 2007;34:13661375.

    • Search Google Scholar
    • Export Citation
  • 42

    Miranda EP, Gertner M, Wall J. Routine imaging of asymptomatic melanoma patients with metastasis to sentinel lymph nodes rarely identifies systemic disease. Arch Surg 2004;139:831837.

    • Search Google Scholar
    • Export Citation
  • 43

    Constantinidou A, Hofman M, O’Doherty M. Routine positive emission tomography and positron emission tomography/computed tomography in melanoma staging with positive sentinel node biopsy is of limited benefit. Melanoma Res 2008;18:5660.

    • Search Google Scholar
    • Export Citation
  • 44

    Aloia TA, Gershenwald JE, Andtbacka RH. Utility of computed tomography and magnetic resonance staging in patients with stage III melanoma diagnosed by sentinel lymphadenectomy. J Clin Oncol 2006;24:28582865.

    • Search Google Scholar
    • Export Citation
  • 45

    Gold JS, Jaques DP, Busam KJ. Yield and predictors of radiologic studies for identifying distant metastases in melanoma patients with a positive sentinel lymph node biopsy. Ann Surg Oncol 2007;14:21332140.

    • Search Google Scholar
    • Export Citation
  • 46

    Kuvshinoff BW, Kurtz C, Coit DG. Computed tomography in evaluation of patients with stage III melanoma. Ann Surg Oncol 1997;4:252258.

  • 47

    Buzaid AC, Tinoco L, Ross MI. Role of computed tomography in the staging of patients with local-regional metastases of melanoma. J Clin Oncol 1995;13:21042108.

    • Search Google Scholar
    • Export Citation
  • 48

    Johnson TM, Fader DJ, Chang AE. Computed tomography in staging of patients with melanoma metastatic to the regional nodes. Ann Surg Oncol 1997;4:396402.

    • Search Google Scholar
    • Export Citation
  • 49

    Tyler DS, Onaitis M, Kherani A. Positron emission tomography scanning in malignant melanoma. Clinical utility in patients with stage III disease. Cancer 2000;89:10191025.

    • Search Google Scholar
    • Export Citation
  • 50

    Damian DL, Fulham MJ, Thompson E, Thompson JF. Positron emission tomography in the detection and management of metatatic melanoma. Melanoma Res 1996;6:325329.

    • Search Google Scholar
    • Export Citation
  • 51

    Brady MS, Akhurst T, Spanknebel K. Utility of preoperative [(18)F flourodeoxyglucose-positron emission tomography scanning in high-risk melanoma patients. Ann Surg Oncol 2006;13:525532.

    • Search Google Scholar
    • Export Citation
  • 52

    Pfannenberg C, Aschoff P, Schanz S. Propspective comparison of (18)F flouroudeoxyglucose positron emission tomography/computed tomography and whole-body magnetic resonance imaging in staging of advanced malignant melanoma. Eur J Cancer 2007;43:557564.

    • Search Google Scholar
    • Export Citation
  • 53

    Reinhardt MJ, Joe AY, Jaeger U. Diagnostic performance of whole body dual modality 18F-FDG PET/CT imaging for N- and M-staging of malignant melanoma: experience with 250 consecutive patients. J Clin Oncol 2006;24:11781187.

    • Search Google Scholar
    • Export Citation
  • 54

    Strobel K, Dummer R, Husarik DB. High risk melanoma: accuracy of FDG PET/CT with added CT morphologic information for detection of metastases. Radiology 2007;244:566574.

    • Search Google Scholar
    • Export Citation
  • 55

    Harris MT, Berlangieri SU, Cebon JS. Impact of 2-deoxy-2[F-18] fluoro-D-glucose postiron emission tomography on the management of patients with advanced melanoma. Mol Imaging Biol 2005;7:304308.

    • Search Google Scholar
    • Export Citation
All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 71 62 3
PDF Downloads 25 21 5
EPUB Downloads 0 0 0