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Khan M, Thompson J, Kiiskila L, Oboh O, Truong T, Prentice A, Assifi MM, Chung M, Wright GP. Timing and necessity of staging imaging in clinical stage II cutaneous melanoma: Cost-effectiveness and clinical decision analysis. Am J Surg 2023; 225:93-98. [PMID: 36400601 DOI: 10.1016/j.amjsurg.2022.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 10/02/2022] [Accepted: 10/12/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Preoperative imaging in clinical stage II melanoma is not indicated per National Comprehensive Cancer Network (NCCN) guidelines but remains common in clinical practice. METHODS Patients presenting with cutaneous clinical stage II melanoma from 2007 to 2019 were retrospectively reviewed. A clinical decision analysis with cost data was designed to understand ideal practice patterns in managing stage II melanoma, with pre-versus selective post-operative imaging as the initial decision node. RESULTS There were 277 subjects included, and 143 underwent preoperative imaging (49.5%). This changed management (i.e. no surgery) in one patient (0.4%). Overall, 16 patients had additional findings on imaging (5.8%). Upfront surgery with selective postoperative imaging was a more cost-effective strategy than routine performance of preoperative imaging, with savings of $1677 per patient. CONCLUSION Preoperative imaging is a low yield, costly approach for patients with clinical stage II melanoma with minimal impact on the decision to proceed with surgical management.
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Affiliation(s)
- Mariam Khan
- Spectrum Health General Surgery Residency Program, 100 Michigan St. NE, Grand Rapids, MI, USA, 49503.
| | - Jessica Thompson
- Spectrum Health General Surgery Residency Program, 100 Michigan St. NE, Grand Rapids, MI, USA, 49503.
| | - Lindsey Kiiskila
- Department of Surgery, Michigan State University College of Human Medicine, 15 Michigan St. NE, Grand Rapids, MI, USA, 49503.
| | - Oselenonome Oboh
- Department of Surgery, Michigan State University College of Human Medicine, 15 Michigan St. NE, Grand Rapids, MI, USA, 49503.
| | - Thao Truong
- Department of Surgery, Michigan State University College of Human Medicine, 15 Michigan St. NE, Grand Rapids, MI, USA, 49503.
| | - Anthony Prentice
- Spectrum Health Department of Nursing, Surgical Services, 100 Michigan St. NE, Grand Rapids, MI, USA, 49503.
| | - M Mura Assifi
- Division of Surgical Oncology, Spectrum Health Medical Group, 145 Michigan St. NE Suite 5500, Grand Rapids, MI, USA, 49503.
| | - Mathew Chung
- Division of Surgical Oncology, Spectrum Health Medical Group, 145 Michigan St. NE Suite 5500, Grand Rapids, MI, USA, 49503.
| | - G Paul Wright
- Division of Surgical Oncology, Spectrum Health Medical Group, 145 Michigan St. NE Suite 5500, Grand Rapids, MI, USA, 49503.
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