Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Staging work-up and surveillance after treatment of melanoma

Antonio C Buzaid, MD
Jeffrey E Gershenwald, MD, FACS
Section Editors
Michael B Atkins, MD
Hensin Tsao, MD, PhD
Deputy Editor
Michael E Ross, MD


Laboratory tests and imaging studies are necessary to accurately stage patients with cancer prior to definitive treatment. However, the staging evaluations used for cancer patients both at the time of initial diagnosis and for follow-up after the initial treatment are often excessive. There are few, if any, established guidelines that define the appropriate tests for the initial evaluation and subsequent follow-up in patients with melanoma.

Practical stage-specific guidelines for the evaluation and follow-up of patients with melanoma are presented here. The melanoma staging system and a review of imaging studies useful in the evaluation of melanoma are presented separately. (See "Tumor node metastasis (TNM) staging system and other prognostic factors in cutaneous melanoma" and "Imaging studies in melanoma".)


Melanoma has the potential to metastasize to any organ; common sites of dissemination include the skin, subcutaneous tissues, lymph nodes, lung, liver, bone, brain, and visceral organs.

However, there is no role for routine imaging studies beyond sentinel lymph node mapping and biopsy in asymptomatic patients with clinical stages I and II disease (table 1A-B and table 2A-B), as the identification of metastatic disease in this setting is negligible:

Lymphatic mapping and sentinel lymph node biopsy – The indications for lymphatic mapping and sentinel lymph node (SLN) biopsy in patients with clinical stage I and II disease are discussed separately. (See "Evaluation and treatment of regional lymph nodes in melanoma".)

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: Jan 18, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Terhune MH, Swanson N, Johnson TM. Use of chest radiography in the initial evaluation of patients with localized melanoma. Arch Dermatol 1998; 134:569.
  2. Buzaid AC, Sandler AB, Mani S, et al. Role of computed tomography in the staging of primary melanoma. J Clin Oncol 1993; 11:638.
  3. Zartman GM, Thomas MR, Robinson WA. Metastatic disease in patients with newly diagnosed malignant melanoma. J Surg Oncol 1987; 35:163.
  4. Ardizzoni A, Grimaldi A, Repetto L, et al. Stage I-II melanoma: the value of metastatic work-up. Oncology 1987; 44:87.
  5. Khansur T, Sanders J, Das SK. Evaluation of staging workup in malignant melanoma. Arch Surg 1989; 124:847.
  6. Iscoe N, Kersey P, Gapski J, et al. Predictive value of staging investigations in patients with clinical stage I malignant melanoma. Plast Reconstr Surg 1987; 80:233.
  7. Bassères N, Grob JJ, Richard MA, et al. Cost-effectiveness of surveillance of stage I melanoma. A retrospective appraisal based on a 10-year experience in a dermatology department in France. Dermatology 1995; 191:199.
  8. Bastiaannet E, Oyen WJ, Meijer S, et al. Impact of [18F]fluorodeoxyglucose positron emission tomography on surgical management of melanoma patients. Br J Surg 2006; 93:243.
  9. Wagner JD, Schauwecker D, Davidson D, et al. Inefficacy of F-18 fluorodeoxy-D-glucose-positron emission tomography scans for initial evaluation in early-stage cutaneous melanoma. Cancer 2005; 104:570.
  10. Fink AM, Holle-Robatsch S, Herzog N, et al. Positron emission tomography is not useful in detecting metastasis in the sentinel lymph node in patients with primary malignant melanoma stage I and II. Melanoma Res 2004; 14:141.
  11. Arrangoiz R, Papavasiliou P, Stransky CA, et al. Preoperative FDG-PET/CT Is an Important Tool in the Management of Patients with Thick (T4) Melanoma. Dermatol Res Pract 2012; 2012:614349.
  12. Ishimori T, Patel PV, Wahl RL. Detection of unexpected additional primary malignancies with PET/CT. J Nucl Med 2005; 46:752.
  13. Gershenwald JE, Ross MI. Sentinel-lymph-node biopsy for cutaneous melanoma. N Engl J Med 2011; 364:1738.
  14. Aloia TA, Gershenwald JE, Andtbacka RH, et al. Utility of computed tomography and magnetic resonance imaging staging before completion lymphadenectomy in patients with sentinel lymph node-positive melanoma. J Clin Oncol 2006; 24:2858.
  15. Miranda EP, Gertner M, Wall J, et al. Routine imaging of asymptomatic melanoma patients with metastasis to sentinel lymph nodes rarely identifies systemic disease. Arch Surg 2004; 139:831.
  16. Gold JS, Jaques DP, Busam KJ, et al. Yield and predictors of radiologic studies for identifying distant metastases in melanoma patients with a positive sentinel lymph node biopsy. Ann Surg Oncol 2007; 14:2133.
  17. Wagner T, Meyer N, Zerdoud S, et al. Fluorodeoxyglucose positron emission tomography fails to detect distant metastases at initial staging of melanoma patients with metastatic involvement of sentinel lymph node. Br J Dermatol 2011; 164:1235.
  18. Buzaid AC, Ross MI, Balch CM, et al. Critical analysis of the current American Joint Committee on Cancer staging system for cutaneous melanoma and proposal of a new staging system. J Clin Oncol 1997; 15:1039.
  19. Buzaid AC, Tinoco L, Ross MI, et al. Role of computed tomography in the staging of patients with local-regional metastases of melanoma. J Clin Oncol 1995; 13:2104.
  20. Kuvshinoff BW, Kurtz C, Coit DG. Computed tomography in evaluation of patients with stage III melanoma. Ann Surg Oncol 1997; 4:252.
  21. Johnson TM, Fader DJ, Chang AE, et al. Computed tomography in staging of patients with melanoma metastatic to the regional nodes. Ann Surg Oncol 1997; 4:396.
  22. Choi EA, Gershenwald JE. Imaging studies in patients with melanoma. Surg Oncol Clin N Am 2007; 16:403.
  23. Bronstein Y, Ng CS, Rohren E, et al. PET/CT in the management of patients with stage IIIC and IV metastatic melanoma considered candidates for surgery: evaluation of the additive value after conventional imaging. AJR Am J Roentgenol 2012; 198:902.
  24. Bastiaannet E, Wobbes T, Hoekstra OS, et al. Prospective comparison of [18F]fluorodeoxyglucose positron emission tomography and computed tomography in patients with melanoma with palpable lymph node metastases: diagnostic accuracy and impact on treatment. J Clin Oncol 2009; 27:4774.
  25. Roth JA, Eilber FR, Bennett LR, Morton DL. Radionuclide photoscanning. Usefulness in preoperative evaluation of melanoma patients. Arch Surg 1975; 110:1211.
  26. Thomas JH, Panoussopoulous D, Liesmann GE, et al. Scintiscans in the evaluation of patients with malignant melanomas. Surg Gynecol Obstet 1979; 149:574.
  27. Damian DL, Fulham MJ, Thompson E, Thompson JF. Positron emission tomography in the detection and management of metastatic melanoma. Melanoma Res 1996; 6:325.
  28. Dietlein M, Krug B, Groth W, et al. Positron emission tomography using 18F-fluorodeoxyglucose in advanced stages of malignant melanoma: a comparison of ultrasonographic and radiological methods of diagnosis. Nucl Med Commun 1999; 20:255.
  29. Holder WD Jr, White RL Jr, Zuger JH, et al. Effectiveness of positron emission tomography for the detection of melanoma metastases. Ann Surg 1998; 227:764.
  30. Steinert HC, Huch Böni RA, Buck A, et al. Malignant melanoma: staging with whole-body positron emission tomography and 2-[F-18]-fluoro-2-deoxy-D-glucose. Radiology 1995; 195:705.
  31. Reinhardt MJ, Joe AY, Jaeger U, et al. Diagnostic performance of whole body dual modality 18F-FDG PET/CT imaging for N- and M-staging of malignant melanoma: experience with 250 consecutive patients. J Clin Oncol 2006; 24:1178.
  32. Goggins WB, Tsao H. A population-based analysis of risk factors for a second primary cutaneous melanoma among melanoma survivors. Cancer 2003; 97:639.
  33. DiFronzo LA, Wanek LA, Elashoff R, Morton DL. Increased incidence of second primary melanoma in patients with a previous cutaneous melanoma. Ann Surg Oncol 1999; 6:705.
  34. Francken AB, Bastiaannet E, Hoekstra HJ. Follow-up in patients with localised primary cutaneous melanoma. Lancet Oncol 2005; 6:608.
  35. Romano E, Scordo M, Dusza SW, et al. Site and timing of first relapse in stage III melanoma patients: implications for follow-up guidelines. J Clin Oncol 2010; 28:3042.
  36. National Comprehensive Cancer Network (NCCN). NCCN Clinical practice guidelines in oncology. http://www.nccn.org/professionals/physician_gls/f_guidelines.asp (Accessed on February 27, 2016).
  37. Francken AB, Accortt NA, Shaw HM, et al. Follow-up schedules after treatment for malignant melanoma. Br J Surg 2008; 95:1401.
  38. Tsao H, Atkins MB, Sober AJ. Management of cutaneous melanoma. N Engl J Med 2004; 351:998.
  39. Shumate CR, Urist MM, Maddox WA. Melanoma recurrence surveillance. Patient or physician based? Ann Surg 1995; 221:566.
  40. Weiss M, Loprinzi CL, Creagan ET, et al. Utility of follow-up tests for detecting recurrent disease in patients with malignant melanomas. JAMA 1995; 274:1703.
  41. Garbe C, Paul A, Kohler-Späth H, et al. Prospective evaluation of a follow-up schedule in cutaneous melanoma patients: recommendations for an effective follow-up strategy. J Clin Oncol 2003; 21:520.
  42. Meyers MO, Yeh JJ, Frank J, et al. Method of detection of initial recurrence of stage II/III cutaneous melanoma: analysis of the utility of follow-up staging. Ann Surg Oncol 2009; 16:941.
  43. Francken AB, Shaw HM, Accortt NA, et al. Detection of first relapse in cutaneous melanoma patients: implications for the formulation of evidence-based follow-up guidelines. Ann Surg Oncol 2007; 14:1924.
  44. Morton RL, Craig JC, Thompson JF. The role of surveillance chest X-rays in the follow-up of high-risk melanoma patients. Ann Surg Oncol 2009; 16:571.
  45. Trotter SC, Sroa N, Winkelmann RR, et al. A Global Review of Melanoma Follow-up Guidelines. J Clin Aesthet Dermatol 2013; 6:18.
  46. Atkins MB, Long GV, Warneke CL, et al Unraveling the prognostic heterogeneity in patients with advanced melanoma between Australia (OZ) and the United States (US): Preliminary report of the PHAMOUS study. J Clin Oncol 28:15s, 2010 (suppl; abstr 8516)