Yield of baseline imaging for distant metastases in high‐risk primary melanoma. Issue 8 (9th March 2022) - Yan, Mabel K.
Abstract: Background: The yield of baseline imaging in patients presenting with higher risk primary tumours, at least American Joint Committee on Cancer 8th edition stage IIC or III melanoma, is unclear. Methods: This retrospective study included patients referred to the Victorian Melanoma Service from January 2017 to April 2020, diagnosed with at least stage IIC or stage III melanoma. Patients with a T4b tumour and no sentinel lymph node biopsy were included as 'T4bNX'. Results: One hundred and sixty‐four patients (median age 65 years) with baseline imaging (T4bNX: 19, IIC: 30, IIIA: 21, IIIB: 43, IIIC: 50, IIID: 1) were included. The majority were male (73%), and those with T4bNX melanoma tended to be older (median age 79 years). Distant metastases were detected in 21% (4/19) of T4bNX, 3% (1/30) of stage IIC, 0% (0/21) of stage IIIA, and 6% (6/94) of stages IIIB–D melanoma patients. All stage III patients with distant metastases had palpable lymphadenopathy a presentation. Two patients had brain metastases, both of whom had T4bNX melanoma and synchronous extra‐cranial metastases. Conclusions: Compared to stage IIC, baseline imaging detects higher rates of extra‐cranial distant disease in stages IIIB–D and T4bNX melanoma. Intracranial imaging has greater yield in patients with distant extra‐cranial disease.