title: Utility of 3-year torso computed tomography and head imaging in asymptomatic patients with high-risk melanoma.
abstract: There is no general consensus regarding the optimal follow-up strategy for patients with melanoma. We sought to determine the utility and cost effectiveness of radiological restaging of patients with stage IIB-IIIC melanoma at the 3-year follow-up time point. A retrospective review of 210 patients diagnosed with stage IIB-IIIC melanoma seen in the Cutaneous Oncology Program at Beth Israel Deaconess Medical Center between January, 2001 and July, 2006 was conducted. Fifty-two patients were asymptomatic and continuously disease free and underwent restaging head computed tomography (CT) or MRI and torso CT scans 3 years after completion of local-regional therapy or initiation of adjuvant treatment. True positive, false positive and normal scans were identified and the cost per diagnosis calculated. Fifty-five percent of patients developed melanoma recurrences: 88% before 3 years (median time to recurrence 12 months, 95% confidence interval: 10-16 months). The majority of patients (69%) recurred with disease symptoms. Twenty-five head CT scans, 27 head MRIs, and 52 torso CTs were performed. One false-positive head CT and five abnormal torso CT scans (three false positive, two true positive) were identified. The total cost per diagnosis was $312,990. Extensive 3-year restaging imaging seems to be of limited value for symptomatic and continuously disease-free patients with stage IIB-IIIC melanoma. Furthermore, given the low risk of recurrence beyond 3 years, it is likely that subsequent routine imaging would have similarly low utility.
authors.affiliation: The Cutaneous Oncology Program, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
authors.forename: Erin R
authors.initials: ER
authors.lastname: DeRose
authors.forename: Alexander
authors.initials: A
authors.lastname: Pleet
authors.forename: Wei
authors.initials: W
authors.lastname: Wang
authors.forename: Virginia J
authors.initials: VJ
authors.lastname: Seery
authors.forename: Mee Young
authors.initials: MY
authors.lastname: Lee
authors.forename: Sharon
authors.initials: S
authors.lastname: Renzi
authors.forename: Ryan J
authors.initials: RJ
authors.lastname: Sullivan
authors.forename: Michael B
authors.initials: MB
authors.lastname: Atkins
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001900:Boston; D003362:Cost-Benefit Analysis; D018572:Disease-Free Survival; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D006258:Head and Neck Neoplasms / Q000000981:diagnostic imaging* / Q000191:economics / Q000628:therapy; D017721:Hospital Costs; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008545:Melanoma / Q000000981:diagnostic imaging* / Q000191:economics / Q000628:therapy; D008875:Middle Aged; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000191:economics; D016896:Treatment Outcome; D055815:Young Adult