USE OF CHEST RADIOGRAPHY IN THE INITIAL EVALUATION OF PATIENTS WITH LOCALIZED MELANOMA

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 data base chart review. Setting: Regional melanoma referral center in an ac ademic medical center. Patients: The melanoma database identified 1032 asymptomatic patients with localized melanoma for retrospective revie w. Of the patients studied, 876 (85%) of 1032 had an initial staging c hest x-ray film performed. A chest x-ray film was considered initial i f performed within 6 months of melanoma diagnosis. Main Outcome Measur e: The rate of positive, negative, and suspicious findings of initial chest x-ray films. Results: One hundred thirty (15%) of 876 patients h ad suspicious findings necessitating additional workup. Based on follo w-up radiologic findings, only 1 (0.1%) of 876 had a true-positive che st x-ray film demonstrating pulmonary metastasis. Conclusions: The yie ld of detection of unsuspected pulmonary metastasis by chest x-ray fil m in the initial evaluation of asymptomatic patients with localized me lanoma was exceedingly low (0.1%). Our results support the concept tha t routine chest radiograph screening in asymptomatic patients presenti ng with stage I and intermediate-thickness (1.5- to 4.0-mm) stage II m elanoma is unlikely to yield true-positive findings of silent pulmonar y metastasis. No definitive conclusions, were drawn for the subset of patients with stage II thick melanoma (>4.0 mm) because of the small n umber of patients (n = 40) in our series. Prospective studies are nece ssary to ultimately define the yield of initial radiographs in asympto matic patients with localized melanoma.