Routine X-ray of the chest is not justified in staging of cutaneous melanoma patients

INTRODUCTION: The incidence of cutaneous melanoma is increasing in Denmark and worldwide. However, the prevalence of distant metastases at the time of diagnosis has decreased to 1%. We therefore questioned the value of routine preoperative chest X-ray (CXR) for staging asymptomatic melanoma patients and hypothesised that routine CXR is not justified.

METHODS: A retrospective study was conducted on patients undergoing wide local excision and sentinel lymph node biopsy for cutaneous melanoma in the period from 2010 to 2014.

RESULTS: A total of 603 patients were included. The mean time of follow-up was 34 months (range: 13-75 months). Of the 603 patients, 25 (4%) had a positive CXR and 578 (96%) had a negative CXR. Four (0.7%) patients had lung metastases of whom two had a true positive and two a false negative CXR, respectively. The sensitivity was 50%, specificity was 96%, the positive predictive value was 8%, and the negative predictive value was 100%.

CONCLUSION: Our results suggest that CXR cannot be justified in the initial staging of cutaneous melanoma patients. The guideline for the treatment of melanoma in Denmark is under revision: The use of CXR has been omitted.

FUNDING: This study received funding from the Department of Plastic Surgery, the Research Council at Herlev Gentofte Hospital and the Danish Cancer Society.

TRIAL REGISTRATION: The Danish Regional Committee on Biomedical Research Ethics (r. no.: H-4-2014-127), the Danish Data Protection Agency (2012-58-0004, local record no.: HEH-2015-003, I-Suite no.: 03436) and the Danish Melan-oma Group.