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The Role of Surveillance Chest X-Rays in the Follow-Up of High-Risk Melanoma Patients

  • Melanomas
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Abstract

We sought to evaluate the accuracy of detecting asymptomatic pulmonary metastases by surveillance chest X-rays (CXRs) in melanoma patients with a positive sentinel node biopsy. Sentinel node–positive patients treated at the Sydney Melanoma Unit between 1994 and 2003 were prospectively enrolled onto a monitoring schedule of 6 monthly CXRs for 5 years, then annual CXRs for another 5 years. The reference standard for pulmonary metastasis was a positive histopathology diagnosis from a lung biopsy. A total of 108 patients were followed for a median of 52.5 months. A total of 21% (23 of 108) developed pulmonary metastases, which were detected in 48% (11 of 23) by surveillance CXR (sensitivity, 48%; 95% confidence interval [95% CI], .27–.68), leading to resection in 13% (3 of 23). CXRs were abnormal in 19 additional patients but not due to recurrence (specificity, 78%; 95% CI, .77–.79). Additional metastatic disease was apparent in 18% of CXR-detected versus 76% of non-CXR-detected patients (p < .05), but median time to diagnosis of pulmonary metastases was 24 months (95% CI, 12–41) versus 16 months (95% CI, 10–30, p = .30 log rank) and median survival of 42 months (95% CI, 24–84) versus 36 months (95% CI, 18–46, p = .53 log rank) were not significantly different. The 6 to 12 monthly surveillance CXRs detected only half of pulmonary metastases, infrequently identified patients for potentially curative surgery, and did not lead to earlier detection of pulmonary metastases. Further, they may cause unnecessary patient anxiety, given the high rate of false-positive findings.

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References

  1. Gershenwald JE, Thompson W, Mansfield PF, et al. Multiinstitutional melanoma lymphatic mapping experience: the prognostic value of sentinel lymph node status in 612 stage I or II melanoma patients. J Clin Oncol. 1999;17:976–83.

    PubMed  CAS  Google Scholar 

  2. Clary BM, Brady MS, Lewis JJ, et al. Sentinel lymph node biopsy in the management of patients with primary cutaneous melanoma: review of a large single-institutional experience with an emphasis on recurrence. Ann Surg Oncol. 2001;233:250–8.

    CAS  Google Scholar 

  3. Chao C, Wong SL, Ross MI, et al. Patterns of early recurrence after sentinel lymph node biopsy for melanoma. Am J Surg. 2002;184:520–4.

    Article  PubMed  Google Scholar 

  4. Morton DL, Thompson JF, Cochran AJ, et al. Sentinel-node biopsy or nodal observation in melanoma. N Engl J Med. 2006;355(28):1307–17.

    Article  PubMed  CAS  Google Scholar 

  5. Gorenstein LA, Putnam JB, Natarajan G, et al. Improved survival after resection of pulmonary metastases from malignant melanoma. Ann Thorac Surg. 1991;52:204–10.

    Article  PubMed  CAS  Google Scholar 

  6. Essner R. Surgical treatment of melanoma. Surg Clin North Am. 2003;83:109–56.

    Article  PubMed  Google Scholar 

  7. Mackie RM, Casinelli N, Ross MI, et al. Clinical management of melanoma. WHO melanoma programme. Milan: Melanoma publications; 1996.

  8. Roberts DL, Anstey AV, Barlow RJ, et al. UK guidelines for the management of cutaneous melanoma. Br J Dermatol. 2002;146:7–17.

    Article  PubMed  CAS  Google Scholar 

  9. van Everdingen JJ, van der Rhee HJ, Koning CC, et al. Guidelines to melanoma, 3rd revision. Ned Tijdschr Geneeskd. 2005;149:1839–43.

    PubMed  Google Scholar 

  10. Australian Cancer Network. Clinical Practice Guidelines: the management of cutaneous melanoma. NHMRC. Canberra: Commonwealth Department of Health; 1999.

  11. Damian DL, Fulham MJ, Thompson E, et al. Positron emission tomography in the detection and management of metastatic melanoma. Melanoma Res. 1996;6:325–9.

    Article  PubMed  CAS  Google Scholar 

  12. Bland M. An Introduction to Medical Statistics. 3rd ed. Oxford: Oxford University Press; 2000.

    Google Scholar 

  13. Hofmann U, Szedlak M, Rittgen W, et al. Primary staging and follow-up in melanoma patients—monocenter evaluation of methods, costs and patient survival. Br J Cancer. 2002;87:151–7.

    Article  PubMed  CAS  Google Scholar 

  14. Tsao H, Feldman M, Fullerton JE, et al. Early detection of asymptomatic pulmonary melanoma metastases by routine chest radiographs is not associated with improved survival. Arch Dermatol. 2004;140:67–70.

    Article  PubMed  Google Scholar 

  15. Weiss M, Loprinzi CL, Creagan ET, et al. Utility of follow-up tests for detecting recurrent disease in patients with malignant melanomas. JAMA. 1995;274:1703–5.

    Article  PubMed  CAS  Google Scholar 

  16. Grimes DA, Schultz KF. Uses and abuses of screening tests. Lancet. 2002;359:881–4.

    Article  PubMed  Google Scholar 

  17. Sackett DL, Haynes RB, Guyatt GH, et al. Clinical Epidemiology—A Basic Science for Clinical Medicine. 2nd ed. Boston: Little, Brown; 1991.

    Google Scholar 

  18. Dalrymple-Hay MJ, Rome PD, Kennedy C, et al. Pulmonary metastatic melanoma—the survival benefit associated with positron emission tomography scanning. Eur J Cardiothorac Surg. 2002;21:611–4.

    Article  PubMed  CAS  Google Scholar 

  19. Tafra L, Dale PS, Wanek LA, et al. Resection and adjuvant immunotherapy for melanoma metastatic to the lung and thorax. J Thorac Cardiovasc Surg. 1995;110:119–28.

    Article  PubMed  CAS  Google Scholar 

  20. Coit DG. Role of surgery for metastatic malignant melanoma: a review. Semin Surg Oncol. 1993;9:239–45.

    PubMed  CAS  Google Scholar 

  21. Gareen IF. Noncompliance in cancer screening trials. Clin Trials. 2007;4:341–9.

    Article  PubMed  Google Scholar 

  22. Kittler H, Weitzdorfer R, Pehamberger H, et al. Compliance with follow-up and prognosis among patients with thin melanomas. Eur J Cancer. 2001;37:1504–9.

    Article  PubMed  CAS  Google Scholar 

  23. Nieweg OE, Kroon BR. The conundrum of follow-up. Should it be abandoned? Surg Oncol Clin N Am. 2006;15:319–30.

    Article  PubMed  Google Scholar 

  24. Kelly J, Henderson M, Thursfield V, et al. The management of primary cutaneous melanoma in Victoria. Med J Aust. 2007;187:511–4.

    PubMed  Google Scholar 

  25. Fields MM, Chevlen E. Screening for disease: making evidence-based choices. Clin J Oncol Nurs. 2006;10:73–6.

    Article  PubMed  Google Scholar 

  26. McGovern PM, Gross CR, Krueger RA, et al. False-positive cancer screens and health-related quality of life. Cancer Nursing. 2004;27:347–52.

    Article  PubMed  Google Scholar 

  27. Hewitson P, Glasziou P, Irwig L, et al. Screening for colorectal cancer using the faecal occult blood test, Hemoccult (review). Cochrane Database Syst Rev. 2007;(1):CD001216.

  28. Baughan CA, Hall VL, Leppard BJ, et al. Follow-up in stage I cutaneous malignant melanoma: an audit. Clin Oncol. 1993;5:174–80.

    Article  CAS  Google Scholar 

  29. McCaffery K, Michie S. Monitoring as a learning and motivational tool. In: Glasziou PP, Irwig L, Aronson JK, editors. Evidence-based Medical Monitoring: From Principles to Practice. Oxford: Blackwell; 2008. p 123–39.

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Authors and Affiliations

  1. School of Public Health, The University of Sydney, Sydney, NSW, Australia

    Rachael L. Morton MScMed & Jonathan C. Craig PhD

  2. The Sydney Melanoma Unit, Royal Prince Alfred and Mater Hospitals, Melanoma Institute Australia, Sydney, NSW, Australia

    Rachael L. Morton MScMed & John F. Thompson MD

  3. Discipline of Surgery, The University of Sydney, Sydney, NSW, Australia

    John F. Thompson MD

Authors
  1. Rachael L. Morton MScMed
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  2. Jonathan C. Craig PhD
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  3. John F. Thompson MD
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Correspondence to John F. Thompson MD.

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Morton, R.L., Craig, J.C. & Thompson, J.F. The Role of Surveillance Chest X-Rays in the Follow-Up of High-Risk Melanoma Patients. Ann Surg Oncol 16, 571–577 (2009). https://doi.org/10.1245/s10434-008-0207-5

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  • DOI: https://doi.org/10.1245/s10434-008-0207-5

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