COMPUTED-TOMOGRAPHY IN EVALUATION OF PATIENTS WITH STAGE-III MELANOMA

Background: Metastatic disease is detected infrequently by computed to mography (CT) in early stage melanoma. The diagnostic yield of routine CT for stage III melanoma is less established, despite extensive use in clinical practice. Methods: Charts from 347 asymptomatic patients w ith stage III melanoma were reviewed. Findings suggestive of metastati c melanoma identified by head or body CT, chest radiography, bone scan , or liver function studies were confirmed histologically or by progre ssion of disease. Results: Individual CT scans identified 33/788 (4.2% ) instances of metastatic melanoma, with 66/788 (8.4%) false positive studies. No metastases were identified among 104 head CT scans. Chest CT had the highest yield in patients with cervical adenopathy (7/35, 2 0%), and the lowest yield with groin adenopathy (1/50, 2%). Pelvic CT diagnosed metastases in 7/94 (7.4%) patients with groin adenopathy, bu t no patients with palpable axillary (n = 76) or cervical (n = 21) nod es. Metastatic melanoma was diagnosed in 11/136 (8.1%) patients having complete body CT imaging (chest, abdomen, and pelvis), including six patients (4.4%) identified by CT alone. Conclusions: Routine CT in pat ients with clinical stage III melanoma infrequently identifies metasta tic disease. Head CT in the asymptomatic patient, chest CT in patients with groin adenopathy, and pelvic CT in the presence of axillary or c ervical adenopathy are not indicated. Selective use of chest CT in pat ients with cervical adenopathy or pelvic CT in the presence of groin d isease may be useful.