Utility of chest X-ray and abdominal ultrasound for stage III cutaneous malignant melanoma

Background: Current Danish Melanoma Guidelines suggest that stage III cutaneous malignant melanoma receive chest X-ray and abdominal ultrasound to exclude lung and liver metastases. The aim of this study was to examine the sensitivity, specificity, and negative predictive value of chest X-ray and abdominal ultrasound in excluding lung and liver metastases in stage III cutaneous malignant melanoma disease. Methods: A retrospective study was conducted on stage III malignant melanoma patients who underwent wide local excision and complete lymph node dissection from 1 January 2009 to 31 December 2012. Patients were identified by procedure codes and cross-checked with the Danish National Pathology Database. Results: Ninety patients were included. All patients had chest X-ray and abdominal ultrasound performed. Five chest X-rays raised suspicion of lung metastases and four ultrasounds of liver metastases. One patient had pleural metastases. Additional imaging and biopsies ruled out metastases in eight of nine cases. Eighty patients had normal imaging, and among these, two had metastases in the lungs and two in the liver at 1-year follow-up. For chest X-ray and abdominal ultrasound, sensitivity, specificity, and negative predictive value were estimated to be 33/0, 95/95, and 98/98 %, respectively. Conclusions: The present study showed little correlation between imaging findings and metastases, suggesting that chest X-ray and abdominal ultrasound might be doubtable in excluding lung and liver metastases in stage III cutaneous malignant melanoma patients. Level of Evidence: Level IV, prognostic study