Research Article| Volume 65, ISSUE 9, P1216-1219, September 2012

Findings of computed tomography in stage IIB and IIC melanoma: A six-year retrospective study in the South-East of Scotland

Published:April 23, 2012DOI:



      Patient prognosis in malignant melanoma is directly related to clinical stage, and accurate staging is key to appropriate management. Revised BAD/BAPS (British Association of Dermatologists/British association of Plastic Surgeons) 2010 guidelines for the management of cutaneous melanoma recommend that Computed Tomography (CT) is no longer indicated for AJCC (American Joint Cancer Committee) IIB and IIC disease (Breslow thickness 2.01 – 4 mm with ulceration or >4 mm), unless the patient is symptomatic. Previous UK guidelines had recommended that all patients with AJCC IIB or worse disease should have chest, abdomen and pelvic CT as staging investigations. New guidelines also now include head CT in their recommendations. Our aim was to investigate regional CT findings in those patients diagnosed with AJCC IIB and IIC disease, and establish whether our findings affirmed new UK guidelines.

      Methods and patient group

      A retrospective review of case notes was performed on 172 cases of AJCC IIB and IIC disease referred across Lothian, Borders and Fife to melanoma services during the period of January 2004 to January 2010. Clinical findings, results of initial and follow-up CT scans along with changes in patient management were noted. Chest, abdomen and pelvic CT scan were defined as one scan as they were always performed together. CT head and CT neck were defined as separate scans. A positive CT result was defined as those reported with metastasis or an indeterminate result leading to further investigations. Change in management was defined as specific active treatment started or stopped eg surgery or chemo/radiotherapy.


      A total of 269 scans were performed on 130/172 patients. One hundred and four initial staging CT scans were performed on 75 patients, and detected one (1.3%) occult melanoma metastasis. At follow-up, 165 scans were performed in 82 patients and detected 56 metastasis in 32(39%) patients leading to a change in management in 29(35%). Two of these 32 patients had occult melanoma metastasis. Symptomatic patients had statistically significant more metastatic disease diagnosed at follow-up CT scanning than asymptomatic patients p < 0.0001. Head CT detected 15/56 (27%) of all metastasis.


      CT scanning should only be performed in AJCC IIB and IIC melanoma patients if symptoms of clinical metastatic disease are present. Head CT should be included in the staging process. Our regional results concur with new BAD/BAPS 2010 guidelines.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Plastic, Reconstructive & Aesthetic Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Dancey A.L.
        • Mahon B.S.
        • Rayatt S.S.
        A review of diagnostic imaging in melanoma.
        J Plast Reconstr Aesthet Surg. 2008; 61: 1275-1283
      1. National Institute for Health and Clinical Excellence. Draft scope for the appraisal of ipilimumab for previously treated unresectable malignant melanoma. Issue Date: February 2011. [Accessibility verified August 22, 2011].

        • Lens M.B.
        • Dawes M.
        Global perspectives of contemporary epidemiological trends of cutaneous malignant melanoma.
        Br J Dermatol. 2004; 150: 179-185
        • Marsden J.R.
        • Newton-Bishop J.A.
        • Burrows L.
        • et al.
        Revised U.K. guidelines for the management of cutaneous melanoma 2010.
        Br J Dermatol. 2010; 163: 238-256
        • Bishop J.A.
        • Corrie P.G.
        • Evans J.
        • et al.
        UK guidelines for the management of cutaneous melanoma.
        Br J Plast Surg. 2002; 55: 46-54
        • Scottish Intercollegiate Guidelines Network (SIGN)
        Cutaneous melanoma -A National clinical guideline.
        (page 21)2003 ([Accessibility verified August 22, 2011])
        • Buzaid A.C.
        • Sandler A.B.
        • Mani S.
        • et al.
        Role of computed tomography in the staging of primary melanoma.
        J Clin Oncol. 1993; 11: 638-643
        • Yancovitz M.
        • Finelt N.
        • Warycha M.A.
        • et al.
        Role of radiologic imaging at the time of initial diagnosis of stage T1b–T3b melanoma.
        Cancer. 2007; 110: 1107-1114
        • Sawyer A.
        • McGoldrick R.B.
        • Mackey S.P.
        • Allan R.
        • Powell B.
        Does staging computered tomography change management in thick malignant melanoma?.
        J Plast Reconstr Aesthet Surg. 2009; 62: 453-456
        • Johnson T.M.
        • Darrel J.F.
        • Chang A.E.
        • et al.
        Computed tomography in staging of patients with melanoma metastatic to the regional nodes.
        Ann Surg Oncol. 1997; 4: 396-402
        • Muller-Horvat C.
        • Radny P.
        • Eigentler T.K.
        • et al.
        Prospective comparison of the impact on tratment decisions of whole-body magnetic resonance imaging and computed tomography in patients with metastatic malignant melanoma.
        Eur J Cancer. 2006; 42: 342-350
        • Reinhardt M.J.
        • Joe A.Y.
        • Jaeger U.
        • et al.
        Diagnostic performance of whole body dual modality 18F-FDG PET/CT imaging for N and M- staging of malignant melanoma: experience with 250 consecutive patients.
        J Clin Oncol. 2006; 24: 1178-1187
        • Falk M.S.
        • Truitt A.K.
        • Coakley F.V.
        • et al.
        Interpretation, accuracy and management implications of FDG PET/CT in cutaneous malignant melanoma.
        Nucl Med Commun. 2007; 28: 273-280
        • Iagaru A.
        • Quon A.
        • Johnson D.
        • et al.
        2-Deoxy-2-[F-18]fluoro-Dglucose positron emission tomography/computed tomography in the management of melanoma.
        Mol Imaging Biol. 2006; 8: 309-314