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Radiographic Staging in Advanced Melanoma Should Be Limited to Selected Patients: Presented at SSO By Jill Stein ST. LOUIS, Mo -- March 8, 2010 -- Radiographic screening in patients with American Joint Committee on Cancer (AJCC) stage III melanoma should be considered only in individuals with the highest risk of synchronous systemic metastasis, according to data presented here at the 2010 Society of Surgical Oncology Annual Cancer Symposium (SSO). Prakash K. Pandalai, MD, Massachusetts General Hospital, Boston, Massachusetts, and colleagues reviewed the records of 58 consecutive asymptomatic patients who underwent standardised radiographic staging work-up at their institution within 6 weeks of being diagnosed with AJCC stage III melanoma. “The primary rationale for radiographic staging in AJCC III melanoma patients [sic] is that early identification of occult systematic metastasis may offer clinically important information and avoid morbidity associated with radical lymph node dissection,” Dr. Pandalai explained on March 6. Improvements in imaging resolution have led to the detection of increasing number of small lesions with uncertain clinical significance, he said. Prior studies have documented high false-positive rates and low true-positive rates but have included a nonstandardised staging process. In the present study, 33% of patients had ulcerated primary tumours; 73% presented with clinically negative lymph nodes that were shown to be positive on sentinel lymph node biopsy; and 54% presented with N1a disease. Of 204 staging exams, 25% were initially reported as “positive.” Of these, 10% were true-positive and 90% were false-positive exams. Of all the patients, 5% had a true-positive finding and 59% had a false-positive result. Twenty-two percent of patients developed a recurrence within 12 months. Dr. Pandalai said that complete radiographic staging should be considered in patients with the highest risk of synchronous systemic metastasis: patients with primary lesions >4 mm thickness, patients with ulcerated primary tumours, patients with massive lymph node involvement, and patients with symptoms suggestive of systemic metastasis. [Presentation title: Clinical Value of Radiographic Staging in Patients Diagnosed With AJCC Stage III Melanoma. Abstract P246] E-mail this page to a friend or colleague! To print, use this version