FDG PET/CT of patients with melanoma: Clinical impact of imaging the lower extremities

Objectives To determine the clinical impact of including lower extremities (LE) in the field of view of FDG PET/CT imaging in patients with melanoma

Methods 429 consecutive FDG PET/CT whole body scans were acquired in 413 patients with cutaneous melanoma between 01/01/2008 and 03/17/2009 in 2 medical centers. Nineteen patients presenting with a melanoma metastasis of unknown primary (UP) were included. The findings in the LE were compared in patients with primaries in the LE versus primaries elsewhere in the body. Malignancy of FDG positive lesions in LE was established by biopsy or clinical and imaging follow-up ranging from 21 to 33 months. The impact on management of including LE in the field of view was reviewed.

Results As presented in the table, there were more malignant findings in the LE for patients with primaries in the LE (37%=40/108) and UP (26.3%=5/19) than those whose primary was outside of the lower extremities (11.2%=34/302). There was a higher proportion of benign findings in the LE for patients with primaries outside the LE. All patients with primary elsewhere and malignant lesions in the LE had disseminated metastases and the management was not changed due to findings in the LE.

Conclusions Lower extremity findings in patients with primary melanoma outside the LE are infrequent, and these findings, when present, do not change overall disease stage or management

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LE Findings