The yield of preoperative PET/CT (PET/CT) for regional and distant metastases for thin/intermediate thickness melanoma is low. Objective of this study is to determine if PET/CT performed for T4 melanomas helps guide management and alter treatment plans. Methods. Retrospective cohort of 216 patients with T4 melanomas treated at two tertiary institutions. Fifty-six patients met our inclusion criteria (T4 lesion, PET/CT and no clinical evidence of metastatic disease). Results. Fifty-six patients (M: 32, F: 24) with median tumor thickness of 6 mm were identified. PET/CT recognized twelve with regional and four patients with metastatic disease. Melanoma-related treatment plan was altered in 11% of the cases based on PET/CT findings. PET/CT was negative 60% of the time, in 35% of the cases; it identified incidental findings that required further evaluation. Conclusion. Patients with T4 lesions, PET/CT changed the treatment plan 18% of the time. Regional findings changed the surgical treatment plan in 11% and the adjuvant plan in 7% of our cases due to the finding of metastatic disease. Additionally 20 patients had incidental findings that required further workup. In this subset of patients, we feel there is a benefit to PET/CT, and further studies should be performed to validate our findings. 1. Introduction Cutaneous malignancies constitute one of the most commonly diagnosed cancers in the United States (USA), comprising more than half of all cancers diagnosed each year [1]. Cutaneous melanoma represents approximately four percent of all skin cancers diagnosed each year, but accounts for approximately 75% of skin-cancer-related deaths. In the USA in the year 2010, 68,130 new cases of melanoma were diagnosed, with 8,700 patients dying of the disease [2]. The incidence is increasing dramatically. The age-adjusted incidence of invasive melanoma in the USA increased from approximately four per 100,000 to 18 per 100,000 in white males between 1973 and 1998 [3]. The incidence of cutaneous melanoma continues to increase dramatically, increasing in men more rapidly than any other malignancy, and in women more rapidly than any other malignancy except for lung cancer [4]. The lifetime risk of developing melanoma for someone born in the USA in the year 2000 is 1 in 41 for men and 1 in 61 for women [3]. 18-Fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) is a useful functional imaging modality for the staging of melanoma and has a potential role in assessing response to therapy. Wahl et al. [5] and Kern [6] demonstrated that
References
[1]
L. J. Christenson, T. A. Borrowman, C. M. Vachon et al., “Incidence of basal cell and squamous cell carcinomas in a population younger than 40 years,” Journal of the American Medical Association, vol. 294, no. 6, pp. 681–690, 2005.
[2]
A. Jemal, R. Siegel, E. Ward, Y. Hao, J. Xu, and M. J. Thun, “Cancer statistics, 2009,” CA Cancer Journal for Clinicians, vol. 59, no. 4, pp. 225–249, 2009.
[3]
R. T. Greenlee, M. B. Hill-Harmon, T. Murray, and M. Thun, “Cancer statistics, 2001,” Ca-A Cancer Journal for Clinicians, vol. 51, no. 1, pp. 15–36, 2001.
[4]
R. A. Desmond and S. J. Soong, “Epidemiology of malignant melanoma,” Surgical Clinics of North America, vol. 83, no. 1, pp. 1–29, 2003.
[5]
R. L. Wahl, G. D. Hutchins, D. J. Buchsbaum, M. Liebert, H. Barton Grossman, and S. Fisher, “18F-2-deoxy-2-fluoro-d-glucose uptake into human tumor xenografts: Feasibility studies for cancer imaging with positron-emission tomography,” Cancer, vol. 67, no. 6, pp. 1544–1550, 1991.
[6]
K. A. Kern, “[14C]deoxyglucose uptake and imaging in malignant melanoma,” Journal of Surgical Research, vol. 50, no. 6, pp. 643–647, 1991.
[7]
G. S. Mijnhout, O. S. Hoekstra, A. Van Lingen et al., “How morphometric analysis of metastatic load predicts the (un)usefulness of PET scanning: the case of lymph node staging in melanoma,” Journal of Clinical Pathology, vol. 56, no. 4, pp. 283–286, 2003.
[8]
M. I. Longo, P. Lázaro, C. Bueno, J. L. Carreras, and R. Montz, “Fluorodeoxyglucose-positron emission tomography imaging versus sentinel node biopsy in the primary staging of melanoma patients,” Dermatologic Surgery, vol. 29, no. 3, pp. 245–248, 2003.
[9]
J. Hafner, M. Hess Schmid, W. Kempf et al., “Baseline staging in cutaneous malignant melanoma,” British Journal of Dermatology, vol. 150, no. 4, pp. 677–686, 2004.
[10]
J. D. Wagner, D. Davidson, J. J. Coleman et al., “Lymph node tumor volumes in patients undergoing sentinel lymph node biopsy for cutaneous melanoma,” Annals of Surgical Oncology, vol. 6, no. 4, pp. 398–404, 1999.
[11]
J. D. Wagner, D. Schauwecker, D. Davidson et al., “Prospective study of fluorodeoxyglucose-positron emission tomography imaging of lymph node basins in melanoma patients undergoing sentinel node biopsy,” Journal of Clinical Oncology, vol. 17, no. 5, pp. 1508–1515, 1999.
[12]
K. P. Friedman and R. L. Wahl, “Clinical use of positron emission tomography in the management of cutaneous melanoma,” Seminars in Nuclear Medicine, vol. 34, no. 4, pp. 242–253, 2004.
[13]
E. P. Miranda, M. Gertner, J. Wall et al., “Routine imaging of asymptomatic melanoma patients with metastasis to sentinel lymph nodes rarely identifies systemic disease,” Archives of Surgery, vol. 139, no. 8, pp. 831–837, 2004.
[14]
P. B. Clark, V. Soo, J. Kraas, P. Shen, and E. A. Levine, “Futility of fluorodeoxyglucose F 18 positron emission tomography in initial evaluation of patients with T2 to T4 melanoma,” Archives of Surgery, vol. 141, no. 3, pp. 284–288, 2006.
[15]
T. Belhocine, G. Pierard, M. De Labrassinne, T. Lahaye, and P. Rigo, “Staging of regional nodes in AJCC stage I and II melanoma: 18FDG PET imaging versus sentinel node detection,” Oncologist, vol. 7, no. 4, pp. 271–278, 2002.
[16]
I. A. Ho Shon, et al., “Imaging in cutaneous melanoma,” Nuclear Medicine Communications, vol. 29, no. 10, pp. 847–876, 2008.
[17]
K. M. Acland, C. Healy, E. Calonje et al., “Comparison of positron emission tomography scanning and sentinel node biopsy in the detection of micrometastases of primary cutaneous malignant melanoma,” Journal of Clinical Oncology, vol. 19, no. 10, pp. 2674–2678, 2001.
[18]
S. E. Finkelstein, J. A. Carrasquillo, J. M. Hoffman et al., “A prospective analysis of positron emission tomography and conventional imaging for detection of stage IV metastatic melanoma in patients undergoing metastasectomy,” Annals of Surgical Oncology, vol. 11, no. 8, pp. 731–738, 2004.
[19]
K. M. Acland, M. J. O'Doherty, and R. Russell-Jones, “The value of positron emission tomography scanning in the detection of subclinical metastatic melanoma,” Journal of the American Academy of Dermatology, vol. 42, no. 4, pp. 606–611, 2000.
[20]
D. S. Tyler, et al., “Positron emission tomography scanning in malignant melanoma,” Cancer, vol. 89, no. 5, pp. 1019–1025, 2000.
[21]
A. Eigtved, A. P. Andersson, K. Dahlstr？m et al., “Use of fluorine-18 fluorodeoxyglucose positron emission tomography in the detection of silent metastases from malignant melanoma,” European Journal of Nuclear Medicine, vol. 27, no. 1, pp. 70–75, 2000.
[22]
S. M. Swetter, L. A. Carroll, D. L. Johnson, and G. M. Segall, “Positron emission tomography is superior to computed tomography for metastatic detection in melanoma patients,” Annals of Surgical Oncology, vol. 9, no. 7, pp. 646–653, 2002.
[23]
M. R. Kell, J. A. Ridge, N. Joseph, and E. R. Sigurdson, “PET CT imaging in patients undergoing sentinel node biopsy for melanoma,” European Journal of Surgical Oncology, vol. 33, no. 7, pp. 911–913, 2007.
[24]
A. M. Fink, S. Holle-Robatsch, N. Herzog et al., “Positron emission tomography is not useful in detecting metastasis in the sentinel lymph node in patients with primary malignant melanoma stage I and II,” Melanoma Research, vol. 14, no. 2, pp. 141–145, 2004.
[25]
K. Havenga, D. C. P. Cobben, W. J. G. Oyen et al., “Fluorodeoxyglycose-positron emission tomography and sentinel lymph node biopsy in staging primary cutaneous melanoma,” European Journal of Surgical Oncology, vol. 29, no. 8, pp. 662–664, 2003.
[26]
F. Crippa, M. Leutner, F. Belli et al., “Which kinds of lymph node metastases can FDG PET detect? A clinical study in melanoma,” Journal of Nuclear Medicine, vol. 41, no. 9, pp. 1491–1494, 2000.
