Routine ultrasonography in melanoma follow-up?

Abstract

1suggest that we should routinely check lymphnode status with ultrasonography in the follow-up of patients with melanoma. Follow-up in patients with cancer aims to improve mortality and morbidity. Early detection of lymph-node metastasis in patients with melanoma seems to be the main goal of follow-up since the survival rate is greater if only one node is involved 2 and if the diameter of the node is less than 15 mm. 3 There is no doubt that examination of lymph nodes with ultrasonography is better than that with palpation in diagnosis of lymph-node metastasis. We used ultrasonography to assess systematically the lymph nodes of 373 patients with melanomas thicker than 0·5 mm between 1995 and 2000. 4 Clinical examination was done four times a year for melanomas with a Breslow index of 1·5 mm or greater (thick) and twice a year for those with a Breslow index of 0·5–1·5 mm (thin). Ultrasonography was done twice a year for thick melanomas and once a year for thin melanomas. 1909 paired clinical and ultrasonography examinations were done. Biopsy samples were taken from the nodes of 65 patients, 54 of whom were shown to have melanoma metastases. The sensitivity of ultrasonography was 92·9% (95% CI 80·5–98·5), compared with 71·4% (55·4–94·3) for clinical examination, 4 as in other studies. However, we also chose to express the results in terms of usefulness—ie, the proportion of patients who benefited from ultrasonography. Only 27 (7%) patients benefited from ultrasonography (lymph-node metastasis was detected early [n=12], or unnecessary surgery was avoided [n=15]), whereas 25 (6%) patients had some deleterious effect from ultrasonography (unnecessary stress caused by repetition of ultrasonography for benign lymph nodes [n=22], or unnecessary removal of benign lymph node [n=3]). In fact, most (87%, 324) patients did not have any advantage or disadvantage of ultrasonography. The benefit of systematic ultrasonography is thus questionable. 4