Don’t routinely order imaging studies for initial staging purposes prior to surgery on a patient with clinically localized primary cutaneous melanoma unless there is suspicion for metastatic disease based on history and/or physical exam.
Routine imaging studies for localized melanoma including chest radiographs, brain MRI, cross-sectional imaging and PET/CT are insensitive at the lower limits of resolution and do not significantly improve staging of these patients. There is a low risk of metastases and also a risk of detecting findings unrelated to the melanoma (e.g., false positive findings or incidental, unrelated findings). Imaging should be performed if there are concerning findings on history and physical exam, and such tests should be driven by symptoms.
These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.
The Society of Surgical Oncology (SSO) maintains disease site workgroups (DSWGs) to represent the various disease sites associated with surgical oncology. The DSWGs are comprised of experts in the following disease sites: gastrointestinal, melanoma/sarcoma, breast, hepatobiliary, endocrine/head & neck, colorectal and peritoneal surface malignancy. The SSO Quality Committee initiated the Choosing Wisely measure development process by asking the DSWGs to identify tests or procedures commonly used in their respective areas of expertise whose necessity should be questioned and discussed. The Quality Committee received submissions from six disease sites; however, because the list was limited to five measures, the Committee felt it was precluded from incorporating measures representing all disease sites. As a means of refining the list of Choosing Wisely measures, the Quality Committee elected to include the five measures impacting the largest number of patients. The draft list was reduced significantly – eliminating the gastrointestinal, endocrine, hepatobiliary, sarcoma and peritoneal surface malignancies measures. The five measures were selected from the breast, colorectal and melanoma sets. These five measures were submitted to and approved by the SSO Executive Council.
Quality Committee Members
- Sandra Wong, MD, MS, Chair
- David Shibata, MD, Vice Chair
- Dave Bentrem, MD
- Ned Carp, MD
- Fabian Johnston, MD, MHS
- Tari King, MD
- Larissa Temple, MD
- Sharon Weber, MD
Wang TS, Johnson TM, Cascade PN, Redman BG, Sondak VK, Schwartz JL. Evaluation of staging chest radiographs and serum lactate dehydrogenase for localized melanoma. J Am Acad Dermatol 2004 Sep;51:399-405.
Mohr P, Eggermont AM, Hauschild A, Buzaid A. Staging of cutaneous melanoma. Ann Oncol. 2009 Aug;20 Suppl 6:vi14-21.