title: Routine X-ray of the chest is not justified in staging of cutaneous melanoma patients.
abstract: BACKGROUND
  The incidence of cutaneous melanoma is increasing in Denmark and worldwide. However, the prevalence of distant metastases at the time of diagnosis has decreased to 1%. We therefore questioned the value of routine preoperative chest X-ray (CXR) for staging asymptomatic melanoma patients and hypothesised that routine CXR is not justified.
  
  
  METHODS
  A retrospective study was conducted on patients undergoing wide local excision and sentinel lymph node biopsy for cutaneous melanoma in the period from 2010 to 2014.
  
  
  RESULTS
  A total of 603 patients were included. The mean time of follow-up was 34 months (range: 13-75 months). Of the 603 patients, 25 (4%) had a positive CXR and 578 (96%) had a negative CXR. Four (0.7%) patients had lung metastases of whom two had a true positive and two a false negative CXR, respectively. The sensitivity was 50%, specificity was 96%, the positive predictive value was 8%, and the negative predictive value was 100%.
  
  
  CONCLUSIONS
  Our results suggest that CXR cannot be justified in the initial staging of cutaneous melanoma patients. The guideline for the treatment of melanoma in Denmark is under revision: The use of CXR has been omitted.
  
  
  BACKGROUND
  This study received funding from the Department of Plastic Surgery, the Research Council at Herlev Gentofte Hospital and the Danish Cancer Society.
  
  
  BACKGROUND
  The Danish Regional Committee on Biomedical Research Ethics (r. no.: H-4-2014-127), the Danish Data Protection Agency (2012-58-0004, local record no.: HEH-2015-003, I-Suite no.: 03436) and the Danish Melan-oma Group.
authors.affiliation: caroline@gjorup.com.
authors.forename: Caroline Asirvatham
authors.initials: CA
authors.lastname: Gjørup
authors.forename: Helle Westergren
authors.initials: HW
authors.lastname: Hendel
authors.forename: Rita Kaae
authors.initials: RK
authors.lastname: Pilegaard
authors.forename: Cecilie Balslev
authors.initials: CB
authors.lastname: Willert
authors.forename: Lisbet Rosenkrantz
authors.initials: LR
authors.lastname: Hölmich
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005188:False Negative Reactions; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary*; D008297:Male; D008545:Melanoma / Q000000981:diagnostic imaging* / Q000556:secondary*; D008875:Middle Aged; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D057234:Preoperative Period; D013902:Radiography, Thoracic; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy; D012878:Skin Neoplasms / Q000473:pathology*; D055815:Young Adult