Objective There is no general consensus regarding the optimal follow-up strategy for patients with melanoma. We sought to determine the utility and cost effectiveness of radiologic restaging of patients with stage IIB-IIIC melanoma at the 3-year follow-up time point. Methods A retrospective review of 210 patients diagnosed with stage IIB–IIIC melanoma seen in the Cutaneous Oncology Program at Beth Israel Deaconess Medical Center (BIDMC) between January, 2001 and July, 2006 was conducted. 52 patients were asymptomatic and continuously disease free and underwent re-staging head CT/MRI and torso CT scans three years after completion of local-regional therapy or initiation of adjuvant treatment. True positive, false positive and normal scans were identified and the cost per diagnosis calculated. Results Fifty-five percent of patients followed at BIDMC recurred; 88% before 3 years (median time to recurrence 12 months, 95% CI: 10–16 months). The majority (69%) recurred with disease symptoms. Twenty five head CT scans, 27 head MRIs, and 52 torso CTs were performed. One false positive head CT and 5 abnormal torso CT scans (3 false positive, 2 true positive) were identified. The total cost per diagnosis was $312,990. Conclusions Extensive 3-year re-staging imaging appears to be of limited value for symptomatic and continuously disease free patients with stage IIB–IIIC melanoma. Furthermore, given the low risk of recurrence beyond 3 years, it is likely that subsequent routine imaging would have similarly low utility.

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Objective-There is no general consensus regarding the optimal follow-up strategy for patients with melanoma. We sought to determine the utility and cost effectiveness of radiologic restaging of patients with stage IIB-IIIC melanoma at the 3-year follow-up time point.Methods-A retrospective review of 210 patients diagnosed with stage IIB-IIIC melanoma seen in the Cutaneous Oncology Program at Beth Israel Deaconess Medical Center (BIDMC) between January, 2001 and July, 2006 was conducted. 52 patients were asymptomatic and continuously disease free and underwent re-staging head CT/MRI and torso CT scans three years after completion of local-regional therapy or initiation of adjuvant treatment. True positive, false positive and normal scans were identified and the cost per diagnosis calculated.Results-Fifty-five percent of patients followed at BIDMC recurred; 88% before 3 years (median time to recurrence 12 months, 95% CI: 10-16 months). The majority (69%) recurred with disease symptoms. Twenty five head CT scans, 27 head MRIs, and 52 torso CTs were performed. One false positive head CT and 5 abnormal torso CT scans (3 false positive, 2 true positive) were identified. The total cost per diagnosis was $312,990.Conclusions-Extensive 3-year re-staging imaging appears to be of limited value for symptomatic and continuously disease free patients with stage IIB-IIIC melanoma. Furthermore, given the low risk of recurrence beyond 3 years, it is likely that subsequent routine imaging would have similarly low utility.