Fluorodeoxyglucose-PET in the management of malignant melanoma
Section snippets
Initial staging of melanoma
Malignant melanoma has a well-known propensity for spreading to unusual sites. Therefore a baseline staging in patients with primary cutaneous malignant melanoma is routine. Melanoma staging is now based on the depth of invasion of the primary lesion. Ulceration upstages patients in each T-stage subgroup, the number of lymph nodes in N staging is significant, and stage IV metastatic disease is subclassified based on anatomic site and elevated serum lactate dehydrogenase. Most of the staging
Restaging of melanoma
FDG-PET is highly sensitive and specific for initial staging and identification of metastatic disease in patients with malignant melanoma. Therefore, FDG-PET can be used for surveillance after treatment in patients with high-risk stage III and IV melanoma (Fig. 7). Many surgeons advocate aggressive surgical excision of metastatic foci as they develop. In patients with known recurrence of melanoma, FDG-PET scanning has been shown to detect additional unsuspected sites of disease and to result in
Impact on patient management
Many authors have evaluated the impact of FDG-PET on the management of patients with malignant melanoma [24], [28], [29], [32], [33], [36], [37]. PET can affect therapeutic planning in many ways (Fig. 8). Damian et al [24] studied 100 patients and reported that surgical or medical management was specifically influenced by PET findings in 22 patients and that PET was used to clarify another 12 cases in which CT findings were inconclusive. Tyler et al [28], in a prospective study of 106 scans in
Summary
FDG-PET is of limited use in patients with early-stage disease without nodal or distant metastases (stage I–II), because sentinel node biopsy is much more sensitive in detecting microscopic lymph node metastases. Because of the high tumor-to-background ratio, FDG-PET can highlight metastases at unusual sites that are easily missed with conventional imaging modalities. PET has been shown to have a strong role in detecting metastatic disease. FDG-PET is more sensitive than CT for detecting
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