title: Staging studies for cutaneous melanoma in the United States: a population-based analysis.
abstract: BACKGROUND
  Routine cross-sectional imaging for staging of early-stage cutaneous melanoma is not recommended. This study sought to investigate the use of imaging for staging of cutaneous melanoma in the United States.
  
  
  METHODS
  Patients with nonmetastatic cutaneous melanoma newly diagnosed between 2000 and 2007 were identified from the Surveillance Epidemiology End Results-Medicare registry. Any imaging study performed within 90 days after diagnosis was considered a staging study.
  
  
  RESULTS
  The study identified 25,643 patients, 3,116 (12.2 %) of whom underwent cross-sectional imaging: positron emission tomography (PET) (7.2 %), computed tomography (CT) (5.9 %), and magnetic resonance imaging (MRI) (0.6 %). From 2000 to 2007, the use of cross-sectional imaging increased from 8.7 to 16.1 % (p < 0.001), driven predominantly by increased usage of PET (4.2-12.1 %). Stratification by T and N classification showed that cross-sectional imaging was used for 8.6 % of T1, 14.3 % of T2, 18.6 % of T3, and 26.7 % of T4 tumors (p < 0.001) and for 33.3 % of node-positive patients versus 11.1 % of node-negative patients (p < 0.001). Factors predictive of cross-sectional imaging included T classification [odds ratio (OR) for T4 vs T1, 2.66; 95 % confidence interval (CI) 2.33-3.03], node positivity (OR 2.70; 95 % CI 2.36-3.10), more recent year of diagnosis (OR 2.05 for 2007 vs 2000; 95 % CI 1.74-2.42), atypical histology, and non-Caucasian race (OR 1.32; 95 % CI 1.02-1.73).
  
  
  CONCLUSIONS
  The use of cross-sectional imaging for staging of early-stage cutaneous melanoma is increasing in the Medicare population. Better dissemination of guidelines and judicious use of imaging should be encouraged.
authors.affiliation: Department of Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA, wasif.nabil@mayo.edu.
authors.forename: Nabil
authors.initials: N
authors.lastname: Wasif
authors.forename: David
authors.initials: D
authors.lastname: Etzioni
authors.forename: Dana
authors.initials: D
authors.lastname: Haddad
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Gray
authors.forename: Sanjay P
authors.initials: SP
authors.lastname: Bagaria
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Pockaj
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000493:pharmacokinetics; D005500:Follow-Up Studies; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008545:Melanoma / Q000175:diagnosis* / Q000453:epidemiology*; D009367:Neoplasm Staging / Q000379:methods*; D049268:Positron-Emission Tomography; D011379:Prognosis; D019275:Radiopharmaceuticals / Q000493:pharmacokinetics; D018426:SEER Program; D012878:Skin Neoplasms; D014018:Tissue Distribution; D014057:Tomography, X-Ray Computed; D014481:United States / Q000453:epidemiology; D000096142:Cutaneous Malignant Melanoma
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18