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. 2019 Apr 15;9(2):168-175.
eCollection 2019.

Evaluation of PET/CT in patients with stage III malignant cutaneous melanoma

Lennaert Cb Groen  1 , Sergiy V Lazarenko  2 , Hermien Wh Schreurs  1 , Milan C Richir  3
Affiliations

Evaluation of PET/CT in patients with stage III malignant cutaneous melanoma

Lennaert Cb Groen et al. Am J Nucl Med Mol Imaging. .

Abstract

In order to evaluate if patients with stage III-IV MCM are eligible for curative treatment PET/CT is performed. Since the diagnostic value of PET/CT is not unambiguously, a retrospective cohort study is performed to tailor optimal indication of PET/CT in patients with stage III MCM. A retrospective cohort study was conducted of all patients with stage III disease in a large oncologic teaching hospital in which PET/CT was performed from 2012 to 2016. The primary tumor- and regional lymph node characteristics were assessed to predict distant metastasis seen on PET/CT. A total of 73 patients were included of which 18% were restaged as stage IV by PET/CT. Twenty percent of the patients with a positive lymph node and 14% of patients with in transit metastasis or satellite lesions were restaged to stage IV. T-classification, ulceration and N-classification did not predict distant metastasis. Localization of the primary tumor significantly differed (P = 0.004). Localization on the head/neck resulted in a 32 greater odds of distant metastasis (P = 0.008). After a median follow-up of 36 months, 13 out of 60 (27%) stage III MCM patients were restaged as stage IV after the first performed PET/CT. This retrospective cohort study resulted in restaging of 18% of the stage III MCM patients by PET/CT, with therapeutic consequences. Patients with stage III MCM on the head/neck seem to have more distant spreading of the tumor than other localizations. Further investigation is needed, with larger sample sizes, to guide optimal indication of PET/CT.

Keywords: Malignant cutaneous melanoma; PET/CT; retrospective cohort; stage III.

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Conflict of interest statement

None.

Figures

Figure 1
Figure 1
A 65-year old male with distant metastasis seen on PET/CT. This patient is diagnosed with a pT4a MCM frontotemporal. Pathological positive lymph nodes preauricular were observed. PET/CT revealed lymphatic and hepatic metastasis.
Figure 2
Figure 2
A 69-year old patient with distant metastasis in the follow-up after the first performed PET/CT. A patient with a pT3b superficial spreading melanoma on the left lower extremity. The pathological results of the therapeutic re-excision and sentinel node showed macrometastasis in two of the two lymph nodes. A superficial lymph node dissection was performed which showed micrometastasis in 3 of the 5 lymph nodes. A: PET/CT after a superficial lymph node dissection. No signs of regional- or distant metastasis was seen. B: After 7 months a solitaire FDG-avid pathological inguinal lymph node on the left side was observed. This lymph node was resected and showed regional metastasis without extra nodal growth. No distant metastasis was seen. C: 1 year after the first performed PET/CT regional lymph node metastasis was seen, with signs of distant metastasis in the thyroid gland (pathological proven). A thyroidectomy and inguinal lymphadenectomy was performed. D: 1.5 year after the first performed PET/CT extensive distant metastasis was seen and patient was referred for immunotherapy to a tertiary referral center.
Figure 3
Figure 3
Characterization of PET/CT in a 69-year old patient. A: The initial PET/CT after a superficial lymph node dissection showed no signs of regional- or distant metastasis. B: In further detail, in a PET/CT after 7 months a solitaire FDG-avid pathological inguinal lymph node on the left side was observed. This lymph node was resected and showed regional metastasis without extra nodal growth. No distant metastasis was seen.
See this image and copyright information in PMC

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