Early detection of asymptomatic pulmonary melanoma metastases by routine chest radiographs is not associated with improved survival.

OBJECTIVE To determine if earlier detection of pulmonary metastasis by routine chest radiography (CR) is associated with a prolonged survival. DESIGN A computer-assisted search of all CR reports on patients with melanoma between 1990 and 1994 at the Massachusetts General Hospital, Boston. Positive or suspicious findings for pulmonary metastasis were further pursued through review of medical records and tumor registry files. SETTING AND PATIENTS A hospital-based population of patients with melanoma undergoing routine CR at Massachusetts General Hospital. RESULTS Overall, of 994 patients, 75 were identified as having pulmonary metastases by CR (1937 total chest radiographs). In addition, there were 63 patients with suspicious findings that were later shown to be false positive. Chest radiographs provided the initial evidence of metastases in 41 asymptomatic individuals. Thirty-four patients had known melanoma metastases to other sites at the time of the first abnormal chest radiograph. Survival after identification of pulmonary metastasis did not differ significantly between the 2 groups. CONCLUSIONS In this study, there was no evidence to support the notion that earlier detection of pulmonary metastasis in otherwise asymptomatic individuals confers a survival advantage in an unselected melanoma population.