LABORATORY TESTS AND IMAGING STUDIES IN PATIENTS WITH CUTANEOUS MALIGNANT-MELANOMA

Laboratory tests and imaging studies are often ordered for asymptomati c patients with malignant melanomas (MMs) in an effort to detect subcl inical metastatic disease. However, their sensitivity and specificity for detecting cryptic metastases are not well established. A review of the literature oil laboratory tests and imaging studies for MM metast ases was undertaken to address the usefulness of such investigations i n asymptomatic patients with MM in AJCC (American Joint Committee on C ancer system of classification) stages I, II, and III. A review of the pertinent literature since 1966 was conducted through MEDLINE, Medica , and Cancerlit. Laboratory tests and imaging studies revealed occult MM metastases in only a small number of the thousands of reported pati ents with putative AJCC stage I, II, and III MM. However, for those di agnosed with limited metastases, surgical removal with or without immu notherapy, chemotherapy, or radiotherapy can lead to long-term remissi ons in some patients. For patients with asymptomatic AJCC stage I or I I disease, chest roentgenograms (CXR) and blood lactic dehydrogenase ( LDH) levels may be obtained at low cost and prove to be of benefit if metastases are identified. For patients with AJCC stage III disease, c omputed tomographic (CT) scans of the thorax, abdomen, and pelvis (esp ecially when the primary cutaneous site of the melanoma is below the w aist) may be considered for detecting metastatic MM. Other tests, such as magnetic resonance imaging (MRI) scans of the brain, may be ordere d based on symptoms or physical findings. In the future, technological ly improved techniques and newer methods may prove cost-effective for detecting treatable asymptomatic MM metastases. Furthermore, improveme nt in treatments will also influence the indications for the search fo r occult MM metastases. At this time there is a need for an internatio nal consensus conference on laboratory tests and imaging studies for o ccult melanoma metastases.