A comprehensive analysis of metastatic disease following surgery for clinically localized cutaneous melanoma.

This article examines the utility of baseline staging imaging—such as whole-body computed tomography (CT), positron emission tomography (PET), and brain magnetic resonance imaging (MRI)—in patients with cutaneous malignant melanoma, particularly those with asymptomatic disease and varying lymph node statuses. Using data from the National Cancer Database (2012–2020), the study categorized patients into three clinical scenarios based on lymph node involvement and analyzed the prevalence and risk factors for metastatic disease, including brain metastases. Results showed that metastatic disease and brain metastases were uncommon among patients with clinically node-negative melanoma, even with positive sentinel lymph node biopsy results, while patients with clinically node-positive disease had higher rates of metastases. Key tumor characteristics such as Breslow thickness greater than 4 mm, ulceration, and lymphovascular invasion were associated with increased metastatic risk, suggesting that imaging strategies could be tailored based on individual risk factors rather than applied universally. The study highlights the potential to optimize imaging use to reduce unnecessary procedures, costs, and patient burden, while acknowledging limitations including retrospective design and lack of longitudinal metastatic data.