Review of Evidence-Based Support for Pretreatment Imaging in Melanoma

Abstract

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.

Diagnostic Performance of [18F]F-FDG Positron Emission Tomography (PET) in Non-Ophthalmic Malignant Melanoma: A Systematic Review and Meta-Analysis of More Than 10,000 Melanoma Patients

“…It is also necessary to mention that in addition to the size of regional or distant metastatic lesions, the size of the primary lesion also plays a pivotal role in [ 18 F]F-FDG PET diagnostic performance and, consequently, cost-effectiveness. Patients with a Breslow thickness of <1 mm have an exceedingly low risk for metastasis, rendering [ 18 F]F-FDG PET not cost-effective [ 120 , 121 ]. Patients with an intermediate Breslow thickness (1–4 mm) face an elevated risk of locoregional metastasis but maintain a relatively low risk for distant metastasis (less than 20%).…”

Diagnosis and Work-up of Malignant Melanoma in the Age of Fine Needle Aspiration and Molecular Testing

“…While low-cost studies such as chest radiographs are useful in establishing a baseline, more-expensive imaging techniques may not be cost-effective. 14 Few guidelines exist that define appropriate testing protocols for initial evaluation and follow-up of patients with melanoma. 15 Malignant melanoma has a propensity to metastasise widely with common sites for deposits of melanoma being skin, …”