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In his editorial regarding chest radiography in the initial evaluation of patients with localized melanoma, Gross¹ states, "No studies have been done that satisfactorily proved that it [initial-staging chest x-ray film] is not useful and not cost-effective [in the initial evaluation of melanoma]." The study on this subject by Terhune et al² in the same volume of the ARCHIVES found that only 1 (0.1%) of 876 patients with localized melanoma showed a true-positive chest radiograph for pulmonary metastasis, despite initial suggestive radiographs of 130 other patients.While a specific cost analysis was not performed, the authors stated, "The high false-positive rate of 15% led to costly investigations and contributed to an increase in the patient's anxiety level."

To estimate the cost of detecting a single true-positive finding on a chest radiograph in this group of 876 patients, one could apply data from a study by Tsao et al³ on the direct . . . [Full Text of this Article]

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