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Journal of the American Academy of Dermatology
Volume 39, n° 3
pages 451-463 (septembre 1998)
Doi : 10.1016/S0190-9622(98)70324-X
Laboratory tests and imaging studies in patients with cutaneous malignant melanoma

Carol L. Huang, MDb, Nathalie Provost, MDa, Ashfaq A. Marghoob, MDb, Alfred W. Kopf, MDa, Ludmila Levin, BAa, Robert S. Bart, MDa
New York and Huntington, New York 
From The Ronald O. Perelman Department of Dermatology, New York University School of Medicine and the Oncology Section, Charles C. Harris Skin and Cancer Pavilion, New York University Medical Center, New York City ; The New York University Melanoma Cooperative Groupa; and the Department of Dermatology, State University of New York at Stony Brookb and the Pigmented Lesion and Skin Cancer Section, Huntington Medical Group, Huntington 


Laboratory tests and imaging studies are often ordered for asymptomatic patients with malignant melanomas (MMs) in an effort to detect subclinical metastatic disease. However, their sensitivity and specificity for detecting cryptic metastases are not well established. A review of the literature on laboratory tests and imaging studies for MM metastases was undertaken to address the usefulness of such investigations in asymptomatic patients with MM in AJCC (American Joint Committee on Cancer system of classification) stages I, II, and III. A review of the pertinent literature since 1966 was conducted through MEDLINE, Medica, and Cancerlit. Laboratory tests and imaging studies revealed occult MM metastases in only a small number of the thousands of reported patients with putative AJCC stage I, II, and III MM. However, for those diagnosed with limited metastases, surgical removal with or without immunotherapy, chemotherapy, or radiotherapy can lead to long-term remissions in some patients. For patients with asymptomatic AJCC stage I or II disease, chest roentgenograms (CXR) and blood lactic dehydrogenase (LDH) levels may be obtained at low cost and prove to be of benefit if metastases are identified. For patients with AJCC stage III disease, computed tomographic (CT) scans of the thorax, abdomen, and pelvis (especially when the primary cutaneous site of the melanoma is below the waist) may be considered for detecting metastatic MM. Other tests, such as magnetic resonance imaging (MRI) scans of the brain, may be ordered based on symptoms or physical findings. In the future, technologically improved techniques and newer methods may prove cost-effective for detecting treatable asymptomatic MM metastases. Furthermore, improvement in treatments will also influence the indications for the search for occult MM metastases. At this time there is a need for an international consensus conference on laboratory tests and imaging studies for occult melanoma metastases. (J Am Acad Dermatol 1998;39:451-63.)

The full text of this article is available in PDF format.

 Supported by The Ronald O. Perelman Department of Dermatology, New York University School of Medicine; the Department of Dermatology, State University of New York at Stony Brook; the Joseph H. Hazen Foundation; the Niarchos Fund of the Skin Cancer Foundation; the Mary and Emanuel Rosenfeld Foundation; and the Kaplan Comprehensive Cancer Center (Cancer Center Support Core Grant No 5P30CA-16087-18).
 Reprints are not available from the authors.
 0190-9622/98/$5.00 + 0  16/1/91564

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