The Value Of Surveillance Computed Tomography Scans Of The Pelvis In Patients With Head And Neck Primary Melanomas

e19035 Background: Computed tomography (CT) scans can be of great value to assess distant metastases in melanoma patients with a high risk for tumor recurrence; yet, this potential benefit must be balanced with the cost, discomfort and the radiation exposure associated with the scans. There is a lack of convincing evidence for the benefit of pelvic CT scans in patients with head and neck primary melanomas. We conducted a retrospective study to evaluate the frequency of pelvic metastases as the first site of metastasis in patients with head and neck primary melanomas, in order to justify the use of the pelvic CT scan as a routine staging imaging study. Methods: We searched our institution's patient database for patients with histolologically confirmed head and neck primary melanomas and selected patients with adequate follow up who had a first appointment between January 2002 and January 2005. Results: We identified 146 patients who met our selection criteria. The median age was 59.5 years, and 73% were male. Although scalp (40%) and face (32%) were the most common sites of the primary melanoma, 16% had a primary in the mucosal surface of the sinus and mouth, or conjunctiva. Seventy-five percent of the patients had either stage I or II melanoma at the time of the diagnosis, and 2% had stage IV disease at initial diagnosis. At the median follow-up duration of 49 months, 110 (75%) had developed recurrences, and the median time to the first recurrence was 13 months. A total of 82 (56%) eventually developed distant metastases with only 10 (7%) developing metastases in the pelvis, among which none had pelvic metastases as the first site of recurrence. With 0 missed pelvic metastases among 146 patients, the probability that the true rate of missed metastases is at least 5% is 0.0006. Conclusions: Our study suggests that pelvic CT scans may not be necessary as a routine staging examination in patients with head and neck primary melanomas, even in those with high risk for recurrence and/or metastasis. No significant financial relationships to disclose.