Initial Evaluation of Melanoma: Don't Stop Getting That Chest X-ray . . . Yet.

In his editorial regarding chest radiography in the initial evaluation of patients with localized melanoma, Gross¹ states, "No studies have been done that satisfactorily proved that it [initial-staging chest x-ray film] is not useful and not cost-effective [in the initial evaluation of melanoma]." The study on this subject by Terhune et al² in the same volume of the ARCHIVES found that only 1 (0.1%) of 876 patients with localized melanoma showed a true-positive chest radiograph for pulmonary metastasis, despite initial suggestive radiographs of 130 other patients.While a specific cost analysis was not performed, the authors stated, "The high false-positive rate of 15% led to costly investigations and contributed to an increase in the patient's anxiety level."