Nuclear Medicine Platform for Management of Malignant Melanoma
| Clinical indications | First-line imaging procedures | Comments |
|---|---|---|
| Initial staging | ||
| AJCC stage I or II | LM/SL | SPECT/CT is recommended in head and neck melanomas and in posterior trunk melanomas |
| 18F-FDG PET (or PET/CT) may be indicated eventually in high-risk melanomas* | ||
| AJCC stage III or IV | Whole-body PET or, better, whole-body PET/CT† | 18F-FDG PET alone should be complemented by thoracic CT |
| 18F-FDG PET (or PET/CT) should be complemented by brain MRI | ||
| Restaging | Whole-body PET or, better, PET/CT† | 18F-FDG PET alone should be complemented by thoracic CT |
| 18F-FDG PET (or PET/CT) should be complemented by brain MRI |
↵* Breslow thickness of ≥4 mm, ulceration, high mitotic rate, and melanomas of trunk and upper arms.
↵† Inclusion of images of both upper and lower extremities is recommended for patients with malignant melanomas that involve extremities, and inclusion of images of head is recommended for patients with known or suspected scalp involvement (96).