Clinical value of radiographic staging in patients diagnosed with AJCC stage III melanoma

Abstract

Background: Patients with American Joint Committee on Cancer (AJCC) stage III melanoma represent patients with high risk of systemic relapse. This study evaluates the clinical utility of standardized radiographic staging.

Methods: Consecutive asymptomatic patients underwent standardized radiographic staging workup within 6 weeks of diagnosis. True- and false-positive rates and number of additional examinations generated after a positive initial report were quantified. All suspicious findings were further studied by biopsy and/or by clinical or radiologic assessment.

Results: Fifty-eight patients underwent complete radiographic staging. Nineteen (33%) had ulcerated primary tumors. Forty-two patients (73%) presented with clinically negative lymph nodes that were positive on sentinel lymph node biopsy. Lymph node involvement was classified as N1a in 54%, N2a in 19%, N2b in 3%, and N3 in 22% of patients. Among 204 staging examinations in 58 patients, 52 (25%) were initially reported as positive. Three percent of all examinations proved truly positive; 23% were falsely positive. Analyzed per patient, in 37 (64%) of 58 patients, at least one examination was initially reported as positive. However, only 3 patients (5%) had a true-positive and 34 (59%) had at least one false-positive report. The positive reports of the staging scans generated 45 additional examinations (0.78 per patient).

Conclusions: Radiographic staging in asymptomatic patients with stage III melanoma detects a low number of patients with unsuspected systemic disease. The ratio of falsely to truly positive is approximately 11:1. Radiographic screening should only be considered in patients with high-risk prognostic features or symptoms, or in the context of clinical trials.