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May 1998

Use of Chest Radiography in the Initial Evaluation of Patients With Localized Melanoma

Author Affiliations

From the Departments of Dermatology, Otolaryngology, and Surgery (Division of Plastic Surgery), University of Michigan Medical Center and Comprehensive Cancer Center, Ann Arbor. Dr Terhune is now with the University of Kentucky, Lexington. Dr Swanson is now with the Oregon Health Sciences Center, Portland.

Arch Dermatol. 1998;134(5):569-572. doi:10.1001/archderm.134.5.569

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 database chart review.

Setting  Regional melanoma referral center in an academic medical center.

Patients  The melanoma database identified 1032 asymptomatic patients with localized melanoma for retrospective review. Of the patients studied, 876 (85%) of 1032 had an initial staging chest x-ray film performed. A chest x-ray film was considered initial if performed within 6 months of melanoma diagnosis.

Main Outcome Measure  The rate of positive, negative, and suspicious findings of initial chest x-ray films.

Results  One hundred thirty (15%) of 876 patients had suspicious findings necessitating additional workup. Based on follow-up radiologic findings, only 1 (0.1%) of 876 had a true-positive chest x-ray film demonstrating pulmonary metastasis.

Conclusions  The yield of detection of unsuspected pulmonary metastasis by chest x-ray film in the initial evaluation of asymptomatic patients with localized melanoma was exceedingly low (0.1%). Our results support the concept that routine chest radiograph screening in asymptomatic patients presenting with stage I and intermediate-thickness (1.5- to 4.0-mm) stage II melanoma is unlikely to yield true-positive findings of silent pulmonary metastasis. No definitive conclusions were drawn for the subset of patients with stage II thick melanoma (>4.0 mm) because of the small number of patients (n = 40) in our series. Prospective studies are necessary to ultimately define the yield of initial radiographs in asymptomatic patients with localized melanoma.