Role of Nuclear Medicine in the Management of Cutaneous Malignant Melanoma*
Tarik Z. Belhocine1,
Andrew M. Scott2,
Einat Even-Sapir3,
Jean-Luc Urbain1 and
Richard Essner4
1 Department of Diagnostic Radiology and Nuclear Medicine, St. Joseph's Hospital, London, Ontario, Canada; 2 Centre for PET and Ludwig Institute for Cancer Research, Austin Hospital, Heidelberg, Victoria, Australia; 3 Department of Nuclear Medicine, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; and 4 Department of Surgical Oncology, John Wayne Cancer Institute, Santa Monica, California
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FIGURE 1. According to orderly progression of malignant melanoma, main pathway for tumor spread involves regional lymph nodes draining primary tumor. Melanoma tumor cells may skip first nodal station, resulting in either local (satellite or in-transit) metastases or distant metastases.
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FIGURE 2. Tumor dissemination in CMM involves both lymphatic and hematogenous pathways. During course of disease, any organ may be affected, including skin and subcutaneous, nodal, and visceral sites.
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FIGURE 3. (A) On preoperative lymphoscintigraphy images, planar views with (right) and without (left) 57Co flood revealed 3 hot nodes in both inguinal regions (arrows). (B) On SPECT/CT images, 5 hot nodes (from left to right) were found to be bilateral superficial and deep inguinal node basins and right external iliac pelvic node (arrows).
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FIGURE 4. (A) A 45-y-old-man with history of melanoma of right neck presented with palpable lymph nodes in right neck. 18F-FDG PET showed extensive metastatic disease. (B) A 73-y-old-man with history of melanoma of left scalp presented with undetermined lung nodule in right lower lobe. 18F-FDG PET scan showed single metastasis in right lung; lesion was suitable for resection. (C) A 61-y-old-man with history of melanoma on back presented with posterior neck lesion. 18F-FDG PET scan showed only right axillary mass and no other sites of metastatic disease.
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FIGURE 5. A 70 y-old-man with history of malignant melanoma presented with right axillary lymph node enlargement. (A) Coronal 18F-FDG PET scan showed right axillary disease (arrow). (B) CT scan. (C) Transaxial 18F-FDG PET scan. (D) Coregistered PET/CT images showed uptake of 18F-FDG in right axillary lymph node (arrow).
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FIGURE 6. A 25-y-old-woman with left axillary melanoma on biopsy was referred for PET/CT scan. 18F-FDG PET scans showed 18F-FDG uptake in left axillary node (arrow). Uptake in neck and costovertebral regions was consistent with physiologic muscle and fat uptake (arrow). Thyroid uptake also was noted and was consistent with mild inflammatory change only (arrow). Patient was classified as having AJCC stage IIIB disease.
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FIGURE 7. A 45-y-old-woman with metastatic melanoma was referred for evaluation of paraaortic lymph nodes. (A) Whole-body PET in rotating view showed focal area of 18F-FDG uptake in right upper abdomen (arrow); this uptake was confirmed on transaxial slices from CT scan (B) and PET scan (C). (D) Fused PET/CT images localized 18F-FDG–avid foci in second part of duodenum, consistent with metastatic deposit (arrows). No abnormality of paraaortic lymph nodes was observed.
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Copyright © 2006 by the Society of Nuclear Medicine.
