Melanoma
Kristen E. Rhodin, MD, MHS
General Surgery Resident
Duke University Medical Center
Durham, North Carolina, United States
Kristen E. Rhodin, MD, MHS
General Surgery Resident
Duke University Medical Center
Durham, North Carolina, United States
Margaret O'Connor, MD PhD
General Surgery Resident
Duke University, United States
Kelly Elleson, MD
Research Fellow
Moffitt Cancer Center, United States
Danielle K. DePalo, MD (she/her/hers)
Resident
Department of General Surgery, University of Massachusetts Chan Medical School, Boston, MA, United States
Richard Straker, MD
General Surgery Resident
University of Pennsylvania, United States
Sophia McKinley, MD EdM (she/her/hers)
Surgical Oncologist
Massachusetts General Hospital, United States
Kate Beekman, BS
Medical Student
University of South Florida, Florida, United States
Lily Parker, BS (she/her/hers)
Medical Student
University of South Florida, United States
April Salama, MD
Associate Professor of Medicine
Duke University, United States
Edmund Bartlett, MD
Surgical oncologist
MSKCC
New York, New York, United States
Giorgos Karakousis, MD
Surgical oncologist
Hospital of the University of Pennsylvania, United States
Jonathan S. Zager, MD
Cutaneous Surgeon
H. Lee Moffitt Cancer Center and Research Institute
Tampa, Florida, United States
Douglas S. Tyler, MD
Professor of Surgery
University of Texas Medical Branch
Galveston, Texas, United States
Georgia M. Beasley, MD MHS (she/her/hers)
Associate Professor of Surgery with tenure
Duke University Medical Center
Durham, North Carolina, United States
Jay Lee, MD
Assistant Professor of Surgery
Duke University, United States
National guidelines recommend consideration of imaging to guide management of patients with resected pathologic stage III melanoma; however, definitive recommendations on the types and timing of staging studies before initiation of adjuvant immune checkpoint inhibitor therapy (ICI) are lacking. Herein, we describe contemporary radiographic staging practices at four high-volume melanoma centers.
Methods: Patients with resected, pathologic stage III melanoma receiving adjuvant ICI were identified within a multi-institutional retrospective cohort (2014-2022). Axial and intracranial (IC) staging studies predating the initiation of adjuvant ICI were recorded. Types and timing of staging studies were compared.
Results:
Altogether, 626 patients were identified. Prior to initiation of adjuvant therapy 66.8% of patients had both axial and IC studies, 29.6% had axial imaging alone, 0.5% had IC imaging alone, and 3.2% had neither or was unreported (Figure). Among those receiving axial imaging (N=603), the most common study was PET/CT (75.5%, N=455), followed by CT alone (24.0%, N=145) and MRI (0.5%, N=3). The median time from axial imaging to the initiation of adjuvant therapy was 37 days (IQR 19, 63). 32.7% of patients’ most recent axial imaging before adjuvant therapy was acquired preoperatively, while 67.3% had postoperative axial imaging. Patients receiving preoperative axial staging were more commonly clinical stage III (49.7% vs. 16.5%) and presenting with recurrent disease (23.9% vs. 6.9%), compared to those with postoperative staging scans. Patients receiving preoperative axial imaging were also more likely to receive adjuvant ICI within 6 weeks of surgery (55.8% vs. 30.3%). Among those receiving IC imaging (N=421), the most common study was MRI (92.9%, N=391), followed by CT (7.1%, N=30). The median time from IC imaging to the initiation of adjuvant therapy was 28 days (IQR 14, 53). 15.9% of patients’ most recent IC imaging before adjuvant therapy was acquired preoperatively, while 83.1% had postoperative IC imaging.
Conclusions: Radiographic staging practices remain variable among patients with resected pathologic stage III melanoma prior to initiation of adjuvant immune therapy. The most common radiographic staging strategy was post-operative PET/CT and MRI brain. Further work is needed to determine the optimal timing and/or sequence of radiographic staging prior to initiation of adjuvant immune therapy.