Positron emission tomography for staging and management of malignant melanoma

Abstract

Currently the accepted indication for PET is recurrent melanoma when surgical intervention is being considered. However, other potential indications include the detection of occult or distant metastasis at initial presentation and the clarification of abnormal radiological findings at follow-up. The routine use of PET for American Joint Commission on Cancer stage I or II disease is of uncertain benefit and is not indicated at present.

Pancreatic resection for metastatic melanoma

“…In patients with metastatic melanoma being considered for surgical intervention, PET scanning appears to be a particularly useful assessment tool [30]. PET has a higher sensitivity and speci®city than conventional imaging for detecting metastatic melanoma in all regions of body except the thorax [30,31]. In a study by Rinne and co-workers [31], PET was able to detect abdominal metastases in all known cases (25 of 25), compared with a 32% sensitivity (8 of 25) with conventional imaging.…”

“…This policy makes the identi®cation of all distal disease extremely important. In patients with metastatic melanoma being considered for surgical intervention, PET scanning appears to be a particularly useful assessment tool [30]. PET has a higher sensitivity and speci®city than conventional imaging for detecting metastatic melanoma in all regions of body except the thorax [30,31].…”

85-Year-Old Male with New Onset Melena

“…On MRI, a high intensity T1 signal and mixed intensity T2 signal is consistent with a melanoma [3]. Positron emission tomography can also be used assess for distant disease, with a sensitivity and specificity ranging from 67-100%, and may be superior to CT or MRI [4]. Melanoma is unfortunately an extremely aggressive disease and at the time of diagnosis, local regional and distant disease is found 60% and 30% of the time, respectively [1].…”

Optimal follow-up for melanoma

“…This raises the question of the importance of this relatively new technique in staging any melanoma patient. In several studies, FDG-PET has shown limited sensitivity to detect microscopic lymph node metastases in this selected group of patients with stage I and II melanoma [27][28][29][92][93][94]. Mijnhout et al documented in a systematic review and meta-ana lysis of the literature from the 1990s, a pooled sensitivity of 79% and a specificity of 86% for the detection of melanoma metastases (both lymph nodes and distant) [93].…”