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Malignant Melanoma

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Nuclear Oncology

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Abstract

Malignant melanoma was diagnosed in approximately 68,000 patients in 2010 in the USA. Melanoma accounts for about 3% of all skin cancers. Major parameters that impact ­prognosis include Breslow thickness, ulceration, tumor location, growth pattern, histological ­subtype, patient age, gender and tumor status of regional lymph nodes. Melanomas are staged using the American Joint Committee on Cancer (AJCC) TNM system, which has incorporated the histological status of SLN into its latest staging system version of cutaneous malignant melanoma.

In early stage melanoma (AJCC I–II), sentinel lymph node biopsy (SLNB) is the standard of care for nodal staging. Lymphoscintigraphy with SPECT/CT improves detection of SLN. In AJCC stage I–II melanoma, [18F]FDG PET/CT has poor sensitivity for detection of nodal metastases but is sensitive for detection of distant metastases. In patients with AJCC stage III (regional nodal involvement) or stage IV disease (systemic metastases), [18F]FDG PET/CT is useful to identify metastatic disease. PET imaging in melanoma patients should include the arms and legs, especially in patients whose primary lesions arise on extremities. False-negative results can occur with small skin and brain metastases, and lesions adjacent to the heart, kidneys, or urinary bladder.

Although [18F]FDG PET/CT is more specific in the diagnosis of melanoma pulmonary metastases, chest CT is more sensitive. Most PET false negatives in recurrent disease are typically less than 1 cm in diameter and are mainly pulmonary and hepatic in location, or in the brain. [18F]FDG PET/CT is useful in treatment monitoring of metastatic melanoma and in post-therapy surveillance.

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Authors and Affiliations

  1. Department of Nuclear Medicine and Centre for PET, Austin Hospital, Studley Road, Heidelberg, VIC, 3084, Australia

    Andrew M. Scott MB, MD (SYD), FRACP, DDU

  2. Ludwig Institute for Cancer Research, Austin Hospital, Studley Road, Heidelberg, VIC, 3084, Australia

    Andrew M. Scott MB, MD (SYD), FRACP, DDU

  3. Department of Oncology, Ludwig Institute for Cancer Research, 145 Studley Road, Heidelberg, VIC, 3084, Australia

    Marika Ciprotti MBBS

  4. Centre for PET, Austin Hospital, 145, Studley Road, Heidelberg, VIC, 3084, Australia

    Sze-Ting Lee MBBS, FRACP

Authors
  1. Andrew M. Scott MB, MD (SYD), FRACP, DDU
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  2. Marika Ciprotti MBBS
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  3. Sze-Ting Lee MBBS, FRACP
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Correspondence to Andrew M. Scott MB, MD (SYD), FRACP, DDU .

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Editors and Affiliations

  1. Dept. Radiology, Div. Nuclear Medicine, Memorial Sloan-Kettering Cancer Center, York Ave. 1275, New York, 10021, New York, USA

    H. William Strauss

  2. Centro Regionale di Medicina Nucleare, Universita di Pisa, Via Roma 67, Pisa, 56100, Italy

    Giuliano Mariani

  3. Centro Regionale di Medicina Nucleare, Universita di Pisa, Via Roma 67, Pisa, 56100, Italy

    Duccio Volterrani

  4. Cancer Center, Department of Radiology, Memorial Sloan-Kettering, York Ave. 1275, New York, 10021, New York, USA

    Steven M. Larson

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Scott, A.M., Ciprotti, M., Lee, ST. (2013). Malignant Melanoma. In: Strauss, H., Mariani, G., Volterrani, D., Larson, S. (eds) Nuclear Oncology. Springer, New York, NY. https://doi.org/10.1007/978-0-387-48894-3_24

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