Summary
Introduction
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.
Results
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.
Conclusion
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.
Keywords
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 accessOne-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:
Subscribe to Journal of Plastic, Reconstructive & Aesthetic SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- A review of diagnostic imaging in melanoma.J Plast Reconstr Aesthet Surg. 2008; 61: 1275-1283
National Institute for Health and Clinical Excellence. Draft scope for the appraisal of ipilimumab for previously treated unresectable malignant melanoma. Issue Date: February 2011. http://www.nice.org.uk/nicemedia/live/12092/53378/53378.pdf. [Accessibility verified August 22, 2011].
- Global perspectives of contemporary epidemiological trends of cutaneous malignant melanoma.Br J Dermatol. 2004; 150: 179-185
- Revised U.K. guidelines for the management of cutaneous melanoma 2010.Br J Dermatol. 2010; 163: 238-256
- UK guidelines for the management of cutaneous melanoma.Br J Plast Surg. 2002; 55: 46-54
- Cutaneous melanoma -A National clinical guideline.(page 21)2003 ([Accessibility verified August 22, 2011])
- Role of computed tomography in the staging of primary melanoma.J Clin Oncol. 1993; 11: 638-643
- Role of radiologic imaging at the time of initial diagnosis of stage T1b–T3b melanoma.Cancer. 2007; 110: 1107-1114
- Does staging computered tomography change management in thick malignant melanoma?.J Plast Reconstr Aesthet Surg. 2009; 62: 453-456
- Computed tomography in staging of patients with melanoma metastatic to the regional nodes.Ann Surg Oncol. 1997; 4: 396-402
- 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
- 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
- Interpretation, accuracy and management implications of FDG PET/CT in cutaneous malignant melanoma.Nucl Med Commun. 2007; 28: 273-280
- 2-Deoxy-2-[F-18]fluoro-Dglucose positron emission tomography/computed tomography in the management of melanoma.Mol Imaging Biol. 2006; 8: 309-314
Article info
Publication history
Published online: April 23, 2012
Accepted:
March 27,
2012
Received:
October 17,
2011
Identification
Copyright
© 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Inc. All rights reserved.
