The presence or absence of metastases is important in determining prognosis and treatment options for patients with malignant melanoma (MM). Laboratory tests and imaging studies are ordered for patients with MMs but without symptoms in an effort to detect occult metastases. However, which laboratory tests and imaging studies to order and how often to reorder them is not well established.

Our purpose was to determine which tests and studies are ordered by physicians with major responsibilities for the care of patients with MM.

Physicians were surveyed by questionnaire about the laboratory tests and imaging studies they ordered for MM stages 0, I, II, and III.

Of the 35 physicians queried, 30 (86%) responded to the survey. The majority of physicians order tests as follows: no tests for MM in situ; roentgenography of the chest with or without initial lactic acid dehydrogenase/liver function tests for stages 1, II, and III and during follow-up for stages IB, II, and III (more frequently as the Breslow thickness increases); and baseline computed tomographic or magnetic resonance imaging scans of the chest, abdomen/pelvis, and brain for stage III.

Although the pattern of ordering examinations was similar for the majority of respondents, there was significant variability among experienced physicians in ordering laboratory tests and imaging studies in the search for occult metastases in patients with asymptomatic MM. The laboratory tests and imaging studies ordered and their frequency depend on the stage of the MM and sometimes on other risk factors.