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Staging and Follow-up of Melanoma

Variant: 1   Adult. Newly diagnosed cutaneous or muco-cutaneous melanoma. No signs or symptoms of regional or metastatic disease. No pathologic evidence of regional nodal metastases. Initial staging.
Procedure Appropriateness Category Relative Radiation Level
Lymphoscintigraphy area of interest Usually Appropriate Varies
Radiography chest Usually Not Appropriate ☢
MRI abdomen and pelvis without and with IV contrast Usually Not Appropriate O
MRI abdomen and pelvis without IV contrast Usually Not Appropriate O
MRI head without and with IV contrast Usually Not Appropriate O
MRI head without IV contrast Usually Not Appropriate O
Bone scan whole body Usually Not Appropriate ☢☢☢
CT abdomen and pelvis with IV contrast Usually Not Appropriate ☢☢☢
CT abdomen and pelvis without IV contrast Usually Not Appropriate ☢☢☢
CT chest with IV contrast Usually Not Appropriate ☢☢☢
CT chest without and with IV contrast Usually Not Appropriate ☢☢☢
CT chest without IV contrast Usually Not Appropriate ☢☢☢
CT head and neck with IV contrast Usually Not Appropriate ☢☢☢
CT head and neck without and with IV contrast Usually Not Appropriate ☢☢☢
CT head and neck without IV contrast Usually Not Appropriate ☢☢☢
CT abdomen and pelvis without and with IV contrast Usually Not Appropriate ☢☢☢☢
FDG-PET/CT whole body Usually Not Appropriate ☢☢☢☢

Variant: 2   Adult. Newly diagnosed cutaneous or muco-cutaneous melanoma. Microscopic satellite in primary lesion biopsy specimen, or positive lymph nodes on wide excision or sentinel lymph node biopsy, or suspected regional lymph node involvement based on signs or symptoms. Initial staging.
Procedure Appropriateness Category Relative Radiation Level
FDG-PET/CT whole body Usually Appropriate ☢☢☢☢
US area of interest May Be Appropriate O
MRI abdomen and pelvis without and with IV contrast May Be Appropriate O
MRI abdomen and pelvis without IV contrast May Be Appropriate O
MRI head without and with IV contrast May Be Appropriate O
CT abdomen and pelvis with IV contrast May Be Appropriate ☢☢☢
CT chest with IV contrast May Be Appropriate ☢☢☢
Radiography chest Usually Not Appropriate ☢
MRI head without IV contrast Usually Not Appropriate O
Bone scan whole body Usually Not Appropriate ☢☢☢
CT abdomen and pelvis without IV contrast Usually Not Appropriate ☢☢☢
CT chest without and with IV contrast Usually Not Appropriate ☢☢☢
CT chest without IV contrast Usually Not Appropriate ☢☢☢
CT head with IV contrast Usually Not Appropriate ☢☢☢
CT head without and with IV contrast Usually Not Appropriate ☢☢☢
CT head without IV contrast Usually Not Appropriate ☢☢☢
CT abdomen and pelvis without and with IV contrast Usually Not Appropriate ☢☢☢☢
Lymphoscintigraphy area of interest Usually Not Appropriate Varies

Variant: 3   Adult. Cutaneous or muco-cutaneous melanoma. Negative clinical or surgical regional lymph nodes or metastatic disease at initial diagnosis. Surveillance.
Procedure Appropriateness Category Relative Radiation Level
MRI head without and with IV contrast May Be Appropriate O
CT chest with IV contrast May Be Appropriate ☢☢☢
CT chest without IV contrast May Be Appropriate ☢☢☢
FDG-PET/CT whole body May Be Appropriate ☢☢☢☢
US area of interest Usually Not Appropriate O
Radiography chest Usually Not Appropriate ☢
MRI abdomen and pelvis without and with IV contrast Usually Not Appropriate O
MRI abdomen and pelvis without IV contrast Usually Not Appropriate O
MRI head without IV contrast Usually Not Appropriate O
Bone scan whole body Usually Not Appropriate ☢☢☢
CT abdomen and pelvis with IV contrast Usually Not Appropriate ☢☢☢
CT abdomen and pelvis without IV contrast Usually Not Appropriate ☢☢☢
CT chest without and with IV contrast Usually Not Appropriate ☢☢☢
CT head with IV contrast Usually Not Appropriate ☢☢☢
CT head without and with IV contrast Usually Not Appropriate ☢☢☢
CT head without IV contrast Usually Not Appropriate ☢☢☢
CT abdomen and pelvis without and with IV contrast Usually Not Appropriate ☢☢☢☢

Variant: 4   Adult. Cutaneous or muco-cutaneous melanoma. Positive clinical or surgical regional lymph nodes or metastatic disease at initial diagnosis. Surveillance.
Procedure Appropriateness Category Relative Radiation Level
MRI head without and with IV contrast Usually Appropriate O
CT chest with IV contrast Usually Appropriate ☢☢☢
FDG-PET/CT whole body Usually Appropriate ☢☢☢☢
US area of interest May Be Appropriate O
CT abdomen and pelvis with IV contrast May Be Appropriate ☢☢☢
CT chest without IV contrast May Be Appropriate ☢☢☢
Radiography chest Usually Not Appropriate ☢
MRI abdomen and pelvis without and with IV contrast Usually Not Appropriate O
MRI abdomen and pelvis without IV contrast Usually Not Appropriate O
MRI head without IV contrast Usually Not Appropriate O
Bone scan whole body Usually Not Appropriate ☢☢☢
CT abdomen and pelvis without IV contrast Usually Not Appropriate ☢☢☢
CT chest without and with IV contrast Usually Not Appropriate ☢☢☢
CT head with IV contrast Usually Not Appropriate ☢☢☢
CT head without and with IV contrast Usually Not Appropriate ☢☢☢
CT head without IV contrast Usually Not Appropriate ☢☢☢
CT abdomen and pelvis without and with IV contrast Usually Not Appropriate ☢☢☢☢

Variant: 5   Adult. Recurrent cutaneous, muco-cutaneous, or ocular melanoma. Suspected regional recurrence or metastatic disease. Staging.
Procedure Appropriateness Category Relative Radiation Level
US area of interest Usually Appropriate O
MRI abdomen and pelvis without and with IV contrast Usually Appropriate O
MRI head without and with IV contrast Usually Appropriate O
CT abdomen and pelvis with IV contrast Usually Appropriate ☢☢☢
CT chest with IV contrast Usually Appropriate ☢☢☢
FDG-PET/CT whole body Usually Appropriate ☢☢☢☢
CT chest without IV contrast May Be Appropriate (Disagreement) ☢☢☢
Radiography chest Usually Not Appropriate ☢
MRI abdomen and pelvis without IV contrast Usually Not Appropriate O
MRI head without IV contrast Usually Not Appropriate O
Bone scan whole body Usually Not Appropriate ☢☢☢
CT abdomen and pelvis without IV contrast Usually Not Appropriate ☢☢☢
CT chest without and with IV contrast Usually Not Appropriate ☢☢☢
CT head with IV contrast Usually Not Appropriate ☢☢☢
CT head without and with IV contrast Usually Not Appropriate ☢☢☢
CT head without IV contrast Usually Not Appropriate ☢☢☢
CT abdomen and pelvis without and with IV contrast Usually Not Appropriate ☢☢☢☢

Variant: 6   Adult. Ocular melanoma. Initial staging.
Procedure Appropriateness Category Relative Radiation Level
MRI abdomen and pelvis without and with IV contrast Usually Appropriate O
MRI head without and with IV contrast Usually Appropriate O
FDG-PET/CT whole body Usually Appropriate ☢☢☢☢
US abdomen May Be Appropriate O
CT abdomen and pelvis with IV contrast May Be Appropriate ☢☢☢
Radiography chest Usually Not Appropriate ☢
MRI abdomen and pelvis without IV contrast Usually Not Appropriate O
MRI head without IV contrast Usually Not Appropriate O
Bone scan whole body Usually Not Appropriate ☢☢☢
CT abdomen and pelvis without IV contrast Usually Not Appropriate ☢☢☢
CT chest with IV contrast Usually Not Appropriate ☢☢☢
CT chest without and with IV contrast Usually Not Appropriate ☢☢☢
CT chest without IV contrast Usually Not Appropriate ☢☢☢
CT head with IV contrast Usually Not Appropriate ☢☢☢
CT head without and with IV contrast Usually Not Appropriate ☢☢☢
CT head without IV contrast Usually Not Appropriate ☢☢☢
CT abdomen and pelvis without and with IV contrast Usually Not Appropriate ☢☢☢☢

Panel Members
Christopher Mejias, MDa; Rustain L. Morgan, MDb; Sandeep S. Arora, MBBSc; Brett W. Carter, MDd; Anupama Chundury, MDe; Amanda S. Corey, MDf; Lauren Kim, MDg; Cara E. Morin, MD, PhDh; Umang Swami, MDi; Alicia Terando, MDj; Ashley E. Vorenkamp, MDk; Darcy J. Wolfman, MDl; Terence Z. Wong, MD, PhDm.
Summary of Literature Review
Introduction/Background
Special Imaging Considerations
Discussion of Procedures by Variant
Variant 1:Adult. Newly diagnosed cutaneous or muco-cutaneous melanoma. No signs or symptoms of regional or metastatic disease. No pathologic evidence of regional nodal metastases. Initial staging.
Variant 1:Adult. Newly diagnosed cutaneous or muco-cutaneous melanoma. No signs or symptoms of regional or metastatic disease. No pathologic evidence of regional nodal metastases. Initial staging.
A. Bone scan whole body
Variant 1:Adult. Newly diagnosed cutaneous or muco-cutaneous melanoma. No signs or symptoms of regional or metastatic disease. No pathologic evidence of regional nodal metastases. Initial staging.
B. CT abdomen and pelvis with IV contrast
Variant 1:Adult. Newly diagnosed cutaneous or muco-cutaneous melanoma. No signs or symptoms of regional or metastatic disease. No pathologic evidence of regional nodal metastases. Initial staging.
C. CT abdomen and pelvis without and with IV contrast
Variant 1:Adult. Newly diagnosed cutaneous or muco-cutaneous melanoma. No signs or symptoms of regional or metastatic disease. No pathologic evidence of regional nodal metastases. Initial staging.
D. CT abdomen and pelvis without IV contrast
Variant 1:Adult. Newly diagnosed cutaneous or muco-cutaneous melanoma. No signs or symptoms of regional or metastatic disease. No pathologic evidence of regional nodal metastases. Initial staging.
E. CT chest with IV contrast
Variant 1:Adult. Newly diagnosed cutaneous or muco-cutaneous melanoma. No signs or symptoms of regional or metastatic disease. No pathologic evidence of regional nodal metastases. Initial staging.
F. CT chest without and with IV contrast
Variant 1:Adult. Newly diagnosed cutaneous or muco-cutaneous melanoma. No signs or symptoms of regional or metastatic disease. No pathologic evidence of regional nodal metastases. Initial staging.
G. CT chest without IV contrast
Variant 1:Adult. Newly diagnosed cutaneous or muco-cutaneous melanoma. No signs or symptoms of regional or metastatic disease. No pathologic evidence of regional nodal metastases. Initial staging.
H. CT head and neck with IV contrast
Variant 1:Adult. Newly diagnosed cutaneous or muco-cutaneous melanoma. No signs or symptoms of regional or metastatic disease. No pathologic evidence of regional nodal metastases. Initial staging.
I. CT head and neck without and with IV contrast
Variant 1:Adult. Newly diagnosed cutaneous or muco-cutaneous melanoma. No signs or symptoms of regional or metastatic disease. No pathologic evidence of regional nodal metastases. Initial staging.
J. CT head and neck without IV contrast
Variant 1:Adult. Newly diagnosed cutaneous or muco-cutaneous melanoma. No signs or symptoms of regional or metastatic disease. No pathologic evidence of regional nodal metastases. Initial staging.
K. FDG-PET/CT whole body
Variant 1:Adult. Newly diagnosed cutaneous or muco-cutaneous melanoma. No signs or symptoms of regional or metastatic disease. No pathologic evidence of regional nodal metastases. Initial staging.
L. Lymphoscintigraphy area of interest
Variant 1:Adult. Newly diagnosed cutaneous or muco-cutaneous melanoma. No signs or symptoms of regional or metastatic disease. No pathologic evidence of regional nodal metastases. Initial staging.
M. MRI abdomen and pelvis without and with IV contrast
Variant 1:Adult. Newly diagnosed cutaneous or muco-cutaneous melanoma. No signs or symptoms of regional or metastatic disease. No pathologic evidence of regional nodal metastases. Initial staging.
N. MRI abdomen and pelvis without IV contrast
Variant 1:Adult. Newly diagnosed cutaneous or muco-cutaneous melanoma. No signs or symptoms of regional or metastatic disease. No pathologic evidence of regional nodal metastases. Initial staging.
O. MRI head without and with IV contrast
Variant 1:Adult. Newly diagnosed cutaneous or muco-cutaneous melanoma. No signs or symptoms of regional or metastatic disease. No pathologic evidence of regional nodal metastases. Initial staging.
P. MRI head without IV contrast
Variant 1:Adult. Newly diagnosed cutaneous or muco-cutaneous melanoma. No signs or symptoms of regional or metastatic disease. No pathologic evidence of regional nodal metastases. Initial staging.
Q. Radiography chest
Variant 2:Adult. Newly diagnosed cutaneous or muco-cutaneous melanoma. Microscopic satellite in primary lesion biopsy specimen, or positive lymph nodes on wide excision or sentinel lymph node biopsy, or suspected regional lymph node involvement based on signs or symptoms. Initial staging.
Variant 2:Adult. Newly diagnosed cutaneous or muco-cutaneous melanoma. Microscopic satellite in primary lesion biopsy specimen, or positive lymph nodes on wide excision or sentinel lymph node biopsy, or suspected regional lymph node involvement based on signs or symptoms. Initial staging.
A. Bone scan whole body
Variant 2:Adult. Newly diagnosed cutaneous or muco-cutaneous melanoma. Microscopic satellite in primary lesion biopsy specimen, or positive lymph nodes on wide excision or sentinel lymph node biopsy, or suspected regional lymph node involvement based on signs or symptoms. Initial staging.
B. CT abdomen and pelvis with IV contrast
Variant 2:Adult. Newly diagnosed cutaneous or muco-cutaneous melanoma. Microscopic satellite in primary lesion biopsy specimen, or positive lymph nodes on wide excision or sentinel lymph node biopsy, or suspected regional lymph node involvement based on signs or symptoms. Initial staging.
C. CT abdomen and pelvis without and with IV contrast
Variant 2:Adult. Newly diagnosed cutaneous or muco-cutaneous melanoma. Microscopic satellite in primary lesion biopsy specimen, or positive lymph nodes on wide excision or sentinel lymph node biopsy, or suspected regional lymph node involvement based on signs or symptoms. Initial staging.
D. CT abdomen and pelvis without IV contrast
Variant 2:Adult. Newly diagnosed cutaneous or muco-cutaneous melanoma. Microscopic satellite in primary lesion biopsy specimen, or positive lymph nodes on wide excision or sentinel lymph node biopsy, or suspected regional lymph node involvement based on signs or symptoms. Initial staging.
E. CT chest with IV contrast
Variant 2:Adult. Newly diagnosed cutaneous or muco-cutaneous melanoma. Microscopic satellite in primary lesion biopsy specimen, or positive lymph nodes on wide excision or sentinel lymph node biopsy, or suspected regional lymph node involvement based on signs or symptoms. Initial staging.
F. CT chest without and with IV contrast
Variant 2:Adult. Newly diagnosed cutaneous or muco-cutaneous melanoma. Microscopic satellite in primary lesion biopsy specimen, or positive lymph nodes on wide excision or sentinel lymph node biopsy, or suspected regional lymph node involvement based on signs or symptoms. Initial staging.
G. CT chest without IV contrast
Variant 2:Adult. Newly diagnosed cutaneous or muco-cutaneous melanoma. Microscopic satellite in primary lesion biopsy specimen, or positive lymph nodes on wide excision or sentinel lymph node biopsy, or suspected regional lymph node involvement based on signs or symptoms. Initial staging.
H. CT head with IV contrast
Variant 2:Adult. Newly diagnosed cutaneous or muco-cutaneous melanoma. Microscopic satellite in primary lesion biopsy specimen, or positive lymph nodes on wide excision or sentinel lymph node biopsy, or suspected regional lymph node involvement based on signs or symptoms. Initial staging.
I. CT head without and with IV contrast
Variant 2:Adult. Newly diagnosed cutaneous or muco-cutaneous melanoma. Microscopic satellite in primary lesion biopsy specimen, or positive lymph nodes on wide excision or sentinel lymph node biopsy, or suspected regional lymph node involvement based on signs or symptoms. Initial staging.
J. CT head without IV contrast
Variant 2:Adult. Newly diagnosed cutaneous or muco-cutaneous melanoma. Microscopic satellite in primary lesion biopsy specimen, or positive lymph nodes on wide excision or sentinel lymph node biopsy, or suspected regional lymph node involvement based on signs or symptoms. Initial staging.
K. FDG-PET/CT whole body
Variant 2:Adult. Newly diagnosed cutaneous or muco-cutaneous melanoma. Microscopic satellite in primary lesion biopsy specimen, or positive lymph nodes on wide excision or sentinel lymph node biopsy, or suspected regional lymph node involvement based on signs or symptoms. Initial staging.
L. Lymphoscintigraphy area of interest
Variant 2:Adult. Newly diagnosed cutaneous or muco-cutaneous melanoma. Microscopic satellite in primary lesion biopsy specimen, or positive lymph nodes on wide excision or sentinel lymph node biopsy, or suspected regional lymph node involvement based on signs or symptoms. Initial staging.
M. MRI abdomen and pelvis without and with IV contrast
Variant 2:Adult. Newly diagnosed cutaneous or muco-cutaneous melanoma. Microscopic satellite in primary lesion biopsy specimen, or positive lymph nodes on wide excision or sentinel lymph node biopsy, or suspected regional lymph node involvement based on signs or symptoms. Initial staging.
N. MRI abdomen and pelvis without IV contrast
Variant 2:Adult. Newly diagnosed cutaneous or muco-cutaneous melanoma. Microscopic satellite in primary lesion biopsy specimen, or positive lymph nodes on wide excision or sentinel lymph node biopsy, or suspected regional lymph node involvement based on signs or symptoms. Initial staging.
O. MRI head without and with IV contrast
Variant 2:Adult. Newly diagnosed cutaneous or muco-cutaneous melanoma. Microscopic satellite in primary lesion biopsy specimen, or positive lymph nodes on wide excision or sentinel lymph node biopsy, or suspected regional lymph node involvement based on signs or symptoms. Initial staging.
P. MRI head without IV contrast
Variant 2:Adult. Newly diagnosed cutaneous or muco-cutaneous melanoma. Microscopic satellite in primary lesion biopsy specimen, or positive lymph nodes on wide excision or sentinel lymph node biopsy, or suspected regional lymph node involvement based on signs or symptoms. Initial staging.
Q. Radiography chest
Variant 2:Adult. Newly diagnosed cutaneous or muco-cutaneous melanoma. Microscopic satellite in primary lesion biopsy specimen, or positive lymph nodes on wide excision or sentinel lymph node biopsy, or suspected regional lymph node involvement based on signs or symptoms. Initial staging.
R. US area of interest
Variant 3:Adult. Cutaneous or muco-cutaneous melanoma. Negative clinical or surgical regional lymph nodes or metastatic disease at initial diagnosis. Surveillance.
Variant 3:Adult. Cutaneous or muco-cutaneous melanoma. Negative clinical or surgical regional lymph nodes or metastatic disease at initial diagnosis. Surveillance.
A. Bone scan whole body
Variant 3:Adult. Cutaneous or muco-cutaneous melanoma. Negative clinical or surgical regional lymph nodes or metastatic disease at initial diagnosis. Surveillance.
B. CT abdomen and pelvis with IV contrast
Variant 3:Adult. Cutaneous or muco-cutaneous melanoma. Negative clinical or surgical regional lymph nodes or metastatic disease at initial diagnosis. Surveillance.
C. CT abdomen and pelvis without and with IV contrast
Variant 3:Adult. Cutaneous or muco-cutaneous melanoma. Negative clinical or surgical regional lymph nodes or metastatic disease at initial diagnosis. Surveillance.
D. CT abdomen and pelvis without IV contrast
Variant 3:Adult. Cutaneous or muco-cutaneous melanoma. Negative clinical or surgical regional lymph nodes or metastatic disease at initial diagnosis. Surveillance.
E. CT chest with IV contrast
Variant 3:Adult. Cutaneous or muco-cutaneous melanoma. Negative clinical or surgical regional lymph nodes or metastatic disease at initial diagnosis. Surveillance.
F. CT chest without and with IV contrast
Variant 3:Adult. Cutaneous or muco-cutaneous melanoma. Negative clinical or surgical regional lymph nodes or metastatic disease at initial diagnosis. Surveillance.
G. CT chest without IV contrast
Variant 3:Adult. Cutaneous or muco-cutaneous melanoma. Negative clinical or surgical regional lymph nodes or metastatic disease at initial diagnosis. Surveillance.
H. CT head with IV contrast
Variant 3:Adult. Cutaneous or muco-cutaneous melanoma. Negative clinical or surgical regional lymph nodes or metastatic disease at initial diagnosis. Surveillance.
I. CT head without and with IV contrast
Variant 3:Adult. Cutaneous or muco-cutaneous melanoma. Negative clinical or surgical regional lymph nodes or metastatic disease at initial diagnosis. Surveillance.
J. CT head without IV contrast
Variant 3:Adult. Cutaneous or muco-cutaneous melanoma. Negative clinical or surgical regional lymph nodes or metastatic disease at initial diagnosis. Surveillance.
K. FDG-PET/CT whole body
Variant 3:Adult. Cutaneous or muco-cutaneous melanoma. Negative clinical or surgical regional lymph nodes or metastatic disease at initial diagnosis. Surveillance.
L. MRI abdomen and pelvis without and with IV contrast
Variant 3:Adult. Cutaneous or muco-cutaneous melanoma. Negative clinical or surgical regional lymph nodes or metastatic disease at initial diagnosis. Surveillance.
M. MRI abdomen and pelvis without IV contrast
Variant 3:Adult. Cutaneous or muco-cutaneous melanoma. Negative clinical or surgical regional lymph nodes or metastatic disease at initial diagnosis. Surveillance.
N. MRI head without and with IV contrast
Variant 3:Adult. Cutaneous or muco-cutaneous melanoma. Negative clinical or surgical regional lymph nodes or metastatic disease at initial diagnosis. Surveillance.
O. MRI head without IV contrast
Variant 3:Adult. Cutaneous or muco-cutaneous melanoma. Negative clinical or surgical regional lymph nodes or metastatic disease at initial diagnosis. Surveillance.
P. Radiography chest
Variant 3:Adult. Cutaneous or muco-cutaneous melanoma. Negative clinical or surgical regional lymph nodes or metastatic disease at initial diagnosis. Surveillance.
Q. US area of interest
Variant 4:Adult. Cutaneous or muco-cutaneous melanoma. Positive clinical or surgical regional lymph nodes or metastatic disease at initial diagnosis. Surveillance.
Variant 4:Adult. Cutaneous or muco-cutaneous melanoma. Positive clinical or surgical regional lymph nodes or metastatic disease at initial diagnosis. Surveillance.
A. Bone scan whole body
Variant 4:Adult. Cutaneous or muco-cutaneous melanoma. Positive clinical or surgical regional lymph nodes or metastatic disease at initial diagnosis. Surveillance.
B. CT abdomen and pelvis with IV contrast
Variant 4:Adult. Cutaneous or muco-cutaneous melanoma. Positive clinical or surgical regional lymph nodes or metastatic disease at initial diagnosis. Surveillance.
C. CT abdomen and pelvis without and with IV contrast
Variant 4:Adult. Cutaneous or muco-cutaneous melanoma. Positive clinical or surgical regional lymph nodes or metastatic disease at initial diagnosis. Surveillance.
D. CT abdomen and pelvis without IV contrast
Variant 4:Adult. Cutaneous or muco-cutaneous melanoma. Positive clinical or surgical regional lymph nodes or metastatic disease at initial diagnosis. Surveillance.
E. CT chest with IV contrast
Variant 4:Adult. Cutaneous or muco-cutaneous melanoma. Positive clinical or surgical regional lymph nodes or metastatic disease at initial diagnosis. Surveillance.
F. CT chest without and with IV contrast
Variant 4:Adult. Cutaneous or muco-cutaneous melanoma. Positive clinical or surgical regional lymph nodes or metastatic disease at initial diagnosis. Surveillance.
G. CT chest without IV contrast
Variant 4:Adult. Cutaneous or muco-cutaneous melanoma. Positive clinical or surgical regional lymph nodes or metastatic disease at initial diagnosis. Surveillance.
H. CT head with IV contrast
Variant 4:Adult. Cutaneous or muco-cutaneous melanoma. Positive clinical or surgical regional lymph nodes or metastatic disease at initial diagnosis. Surveillance.
I. CT head without and with IV contrast
Variant 4:Adult. Cutaneous or muco-cutaneous melanoma. Positive clinical or surgical regional lymph nodes or metastatic disease at initial diagnosis. Surveillance.
J. CT head without IV contrast
Variant 4:Adult. Cutaneous or muco-cutaneous melanoma. Positive clinical or surgical regional lymph nodes or metastatic disease at initial diagnosis. Surveillance.
K. FDG-PET/CT whole body
Variant 4:Adult. Cutaneous or muco-cutaneous melanoma. Positive clinical or surgical regional lymph nodes or metastatic disease at initial diagnosis. Surveillance.
L. MRI abdomen and pelvis without and with IV contrast
Variant 4:Adult. Cutaneous or muco-cutaneous melanoma. Positive clinical or surgical regional lymph nodes or metastatic disease at initial diagnosis. Surveillance.
M. MRI abdomen and pelvis without IV contrast
Variant 4:Adult. Cutaneous or muco-cutaneous melanoma. Positive clinical or surgical regional lymph nodes or metastatic disease at initial diagnosis. Surveillance.
N. MRI head without and with IV contrast
Variant 4:Adult. Cutaneous or muco-cutaneous melanoma. Positive clinical or surgical regional lymph nodes or metastatic disease at initial diagnosis. Surveillance.
O. MRI head without IV contrast
Variant 4:Adult. Cutaneous or muco-cutaneous melanoma. Positive clinical or surgical regional lymph nodes or metastatic disease at initial diagnosis. Surveillance.
P. Radiography chest
Variant 4:Adult. Cutaneous or muco-cutaneous melanoma. Positive clinical or surgical regional lymph nodes or metastatic disease at initial diagnosis. Surveillance.
Q. US area of interest
Variant 5:Adult. Recurrent cutaneous, muco-cutaneous, or ocular melanoma. Suspected regional recurrence or metastatic disease. Staging.
Variant 5:Adult. Recurrent cutaneous, muco-cutaneous, or ocular melanoma. Suspected regional recurrence or metastatic disease. Staging.
A. Bone scan whole body
Variant 5:Adult. Recurrent cutaneous, muco-cutaneous, or ocular melanoma. Suspected regional recurrence or metastatic disease. Staging.
B. CT abdomen and pelvis with IV contrast
Variant 5:Adult. Recurrent cutaneous, muco-cutaneous, or ocular melanoma. Suspected regional recurrence or metastatic disease. Staging.
C. CT abdomen and pelvis without and with IV contrast
Variant 5:Adult. Recurrent cutaneous, muco-cutaneous, or ocular melanoma. Suspected regional recurrence or metastatic disease. Staging.
D. CT abdomen and pelvis without IV contrast
Variant 5:Adult. Recurrent cutaneous, muco-cutaneous, or ocular melanoma. Suspected regional recurrence or metastatic disease. Staging.
E. CT chest with IV contrast
Variant 5:Adult. Recurrent cutaneous, muco-cutaneous, or ocular melanoma. Suspected regional recurrence or metastatic disease. Staging.
F. CT chest without and with IV contrast
Variant 5:Adult. Recurrent cutaneous, muco-cutaneous, or ocular melanoma. Suspected regional recurrence or metastatic disease. Staging.
G. CT chest without IV contrast
Variant 5:Adult. Recurrent cutaneous, muco-cutaneous, or ocular melanoma. Suspected regional recurrence or metastatic disease. Staging.
H. CT head with IV contrast
Variant 5:Adult. Recurrent cutaneous, muco-cutaneous, or ocular melanoma. Suspected regional recurrence or metastatic disease. Staging.
I. CT head without and with IV contrast
Variant 5:Adult. Recurrent cutaneous, muco-cutaneous, or ocular melanoma. Suspected regional recurrence or metastatic disease. Staging.
J. CT head without IV contrast
Variant 5:Adult. Recurrent cutaneous, muco-cutaneous, or ocular melanoma. Suspected regional recurrence or metastatic disease. Staging.
K. FDG-PET/CT whole body
Variant 5:Adult. Recurrent cutaneous, muco-cutaneous, or ocular melanoma. Suspected regional recurrence or metastatic disease. Staging.
L. MRI abdomen and pelvis without and with IV contrast
Variant 5:Adult. Recurrent cutaneous, muco-cutaneous, or ocular melanoma. Suspected regional recurrence or metastatic disease. Staging.
M. MRI abdomen and pelvis without IV contrast
Variant 5:Adult. Recurrent cutaneous, muco-cutaneous, or ocular melanoma. Suspected regional recurrence or metastatic disease. Staging.
N. MRI head without and with IV contrast
Variant 5:Adult. Recurrent cutaneous, muco-cutaneous, or ocular melanoma. Suspected regional recurrence or metastatic disease. Staging.
O. MRI head without IV contrast
Variant 5:Adult. Recurrent cutaneous, muco-cutaneous, or ocular melanoma. Suspected regional recurrence or metastatic disease. Staging.
P. Radiography chest
Variant 5:Adult. Recurrent cutaneous, muco-cutaneous, or ocular melanoma. Suspected regional recurrence or metastatic disease. Staging.
Q. US area of interest
Variant 6:Adult. Ocular melanoma. Initial staging.
Variant 6:Adult. Ocular melanoma. Initial staging.
A. Bone scan whole body
Variant 6:Adult. Ocular melanoma. Initial staging.
B. CT abdomen and pelvis with IV contrast
Variant 6:Adult. Ocular melanoma. Initial staging.
C. CT abdomen and pelvis without and with IV contrast
Variant 6:Adult. Ocular melanoma. Initial staging.
D. CT abdomen and pelvis without IV contrast
Variant 6:Adult. Ocular melanoma. Initial staging.
E. CT chest with IV contrast
Variant 6:Adult. Ocular melanoma. Initial staging.
F. CT chest without and with IV contrast
Variant 6:Adult. Ocular melanoma. Initial staging.
G. CT chest without IV contrast
Variant 6:Adult. Ocular melanoma. Initial staging.
H. CT head with IV contrast
Variant 6:Adult. Ocular melanoma. Initial staging.
I. CT head without and with IV contrast
Variant 6:Adult. Ocular melanoma. Initial staging.
J. CT head without IV contrast
Variant 6:Adult. Ocular melanoma. Initial staging.
K. FDG-PET/CT whole body
Variant 6:Adult. Ocular melanoma. Initial staging.
L. MRI abdomen and pelvis without and with IV contrast
Variant 6:Adult. Ocular melanoma. Initial staging.
M. MRI abdomen and pelvis without IV contrast
Variant 6:Adult. Ocular melanoma. Initial staging.
N. MRI head without and with IV contrast
Variant 6:Adult. Ocular melanoma. Initial staging.
O. MRI head without IV contrast
Variant 6:Adult. Ocular melanoma. Initial staging.
P. Radiography chest
Variant 6:Adult. Ocular melanoma. Initial staging.
Q. US abdomen
Summary of Highlights
Supporting Documents

The evidence table, literature search, and appendix for this topic are available at https://acsearch.acr.org/list. The appendix includes the strength of evidence assessment and the final rating round tabulations for each recommendation.

For additional information on the Appropriateness Criteria methodology and other supporting documents, please go to the ACR website at https://www.acr.org/Clinical-Resources/Clinical-Tools-and-Reference/Appropriateness-Criteria.

Appropriateness Category Names and Definitions

Appropriateness Category Name

Appropriateness Rating

Appropriateness Category Definition

Usually Appropriate

7, 8, or 9

The imaging procedure or treatment is indicated in the specified clinical scenarios at a favorable risk-benefit ratio for patients.

May Be Appropriate

4, 5, or 6

The imaging procedure or treatment may be indicated in the specified clinical scenarios as an alternative to imaging procedures or treatments with a more favorable risk-benefit ratio, or the risk-benefit ratio for patients is equivocal.

May Be Appropriate (Disagreement)

5

The individual ratings are too dispersed from the panel median. The different label provides transparency regarding the panel’s recommendation. “May be appropriate” is the rating category and a rating of 5 is assigned.

Usually Not Appropriate

1, 2, or 3

The imaging procedure or treatment is unlikely to be indicated in the specified clinical scenarios, or the risk-benefit ratio for patients is likely to be unfavorable.
Relative Radiation Level Information

Potential adverse health effects associated with radiation exposure are an important factor to consider when selecting the appropriate imaging procedure. Because there is a wide range of radiation exposures associated with different diagnostic procedures, a relative radiation level (RRL) indication has been included for each imaging examination. The RRLs are based on effective dose, which is a radiation dose quantity that is used to estimate population total radiation risk associated with an imaging procedure. Patients in the pediatric age group are at inherently higher risk from exposure, because of both organ sensitivity and longer life expectancy (relevant to the long latency that appears to accompany radiation exposure). For these reasons, the RRL dose estimate ranges for pediatric examinations are lower as compared with those specified for adults (see Table below). Additional information regarding radiation dose assessment for imaging examinations can be found in the ACR Appropriateness Criteria® Radiation Dose Assessment Introduction document.

Relative Radiation Level Designations

Relative Radiation Level*

Adult Effective Dose Estimate Range

Pediatric Effective Dose Estimate Range

O

0 mSv

 0 mSv

☢

<0.1 mSv

<0.03 mSv

☢☢

0.1-1 mSv

0.03-0.3 mSv

☢☢☢

1-10 mSv

0.3-3 mSv

☢☢☢☢

10-30 mSv

3-10 mSv

☢☢☢☢☢

30-100 mSv

10-30 mSv

*RRL assignments for some of the examinations cannot be made, because the actual patient doses in these procedures vary as a function of a number of factors (e.g., region of the body exposed to ionizing radiation, the imaging guidance that is used). The RRLs for these examinations are designated as “Varies.”
References
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The ACR Committee on Appropriateness Criteria and its expert panels have developed criteria for determining appropriate imaging examinations for diagnosis and treatment of specified medical condition(s). These criteria are intended to guide radiologists, radiation oncologists and referring physicians in making decisions regarding radiologic imaging and treatment. Generally, the complexity and severity of a patient’s clinical condition should dictate the selection of appropriate imaging procedures or treatments. Only those examinations generally used for evaluation of the patient’s condition are ranked.  Other imaging studies necessary to evaluate other co-existent diseases or other medical consequences of this condition are not considered in this document. The availability of equipment or personnel may influence the selection of appropriate imaging procedures or treatments. Imaging techniques classified as investigational by the FDA have not been considered in developing these criteria; however, study of new equipment and applications should be encouraged. The ultimate decision regarding the appropriateness of any specific radiologic examination or treatment must be made by the referring physician and radiologist in light of all the circumstances presented in an individual examination.