IN THIS issue of the ARCHIVES, Terhune et al1 present a straightforward and useful analysis of the findings of an initial staging chest x-ray film in their series of patients with melanoma. They report that the chest radiograph of only 1 of their 876 patients showed a true-positive chest x-ray film at the time of diagnosis, but that the radiographs of 130 others had false-positive studies, necessitating additional evaluation. They conclude in part that initial chest x-ray films "may be neither useful nor cost-effective" for patients with stage I or intermediate-thickness stage II melanomas. While this study shows that chest radiography is unlikely to uncover occult pulmonary metastases at the time of diagnosis, it does not dissuade me from continuing to obtain a baseline chest x-ray film for patients with invasive melanoma that is thicker than 0.75 mm.
Gross EA. Initial Evaluation of Melanoma: Don't Stop Getting That Chest X-ray . . . Yet. Arch Dermatol. 1998;134(5):623–624. doi:10.1001/archderm.134.5.623
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