Kevin Noel O'Regan MBChB, Presenter: Nothing to Disclose

Mark Corrigan, Abstract Co-Author: Nothing to Disclose

Conor Oilver Bogue MBBCh, Abstract Co-Author: Nothing to Disclose

Josephine Barry MBBCh, Abstract Co-Author: Nothing to Disclose

Paul Redmond, Abstract Co-Author: Nothing to Disclose

Melanoma is responsible for the greatest number of skin cancer-related deaths worldwide. The aim of our study was to review routine CT staging and follow-up imaging in patients with malignant melanoma and to determine if routine CT brain imaging demonstrated any unexpected metastases.

This was a retrospective study. Patient record numbers were obtained from a local database of melanoma patients. Patient demographics, site of primary lesion and lesion characteristics (Breslow depth, Clarke level, ulceration) were recorded. For those patients who underwent staging or follow-up CT scanning, we recorded the number of CT scans, the presence or absence of brain metastases, and the pattern of metastatic disease.

In the time period from September 2003 to May 2005, 158 patients with malignant melanoma were referred to our department for staging or follow-up CT imaging. 422 CT brain scans were performed on these patients (Range 1 to 7). Cerebral metastases were reported in 4 patients, representing a yield of 0.947%. All of these patients had new neurological symptoms and signs at the time of CT scanning.

Routine CT brain examination in asymptomatic patients with melanoma is very low yield. We believe that this does not justify the radiation exposure to the patient, or the time and resources in a busy radiology department.

Recently published data has shown that routine imaging studies in patients with AJCC stage I/II (cutaneous) melanoma should not be performed unless there are signs or symptoms of metastasis. Buzaid et al examined a cohort of 89 asymptomatic patients with local/regional lymph node metastases, none of whom had brain metastases on CT or MRI imaging. We confirm these findings and have shown in our series that routine CT brain imaging in staging and follow-up of all patients with melanoma is of low yield with a positive scan rate of less than 1%. There were no positive studies in patients without signs and symptoms of cerebral metastases. As a result of this study we have changed our local practice.

O'Regan, K, Corrigan, M, Bogue, C, Barry, J, Redmond, P, Is Routine Brain CT Imaging Worthwhile in Patients with Malignant Melanoma?.  Radiological Society of North America 2006 Scientific Assembly and Annual Meeting, November 26 - December 1, 2006 ,Chicago IL. http://archive.rsna.org/2006/4440224.html