Use of chest radiography in the initial evaluation of patients with localized melanoma.

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Abstract
THE MAJORITY of patients with melanoma present with local disease (American Joint Committee on Cancer [AJCC] stages I and II) with a 5-year survival rate of approximately 80%.1,2 These data indicate that 20% of patients with stages I and II disease have occult distant metastases at the time of diagnosis. In an attempt to detect these occult lesions, an initial staging evaluation is often performed on patients newly diagnosed as having melanoma. While a detailed medical history taking and physical examination are essential for this purpose, there are few data to support the use of screening studies such as chest x-ray films,3-7 computed tomographic (CT) scans,8,9 liver-spleen scans,3-6,10-12 bone scans,3-6,10,11 and brain scans3-6,10-12 in asymptomatic patients. Despite this, the initial workup for patients with localized melanoma often includes multiple diagnostic studies, most frequently chest radiography. This may be due to the ease of ordering and performing the test and because the lung is the most common visceral site for metastases.7,13 We performed a retrospective analysis to evaluate the use of chest x-ray films in the initial screening evaluation of patients with localized melanoma.