Abstract
In this pictorial review chapter, we present a series of cases highlighting the utility of nuclear medicine in melanoma management and outline some important pitfalls. We highlight the ability of SPECT/CT to demonstrate atypical drainage pathways that are difficult to identify on conventional planar imaging. Whilst SPECT/CT enables precise localisation of sentinel nodes, there is reduced sensitivity near the site of injection owing to flare of activity which may result in false-negative findings. For PET/CT, we demonstrate the high sensitivity of PET to detect sub-centimetre metastases, and its essential application prior to surgical intervention to accurately stage the patient and also the ability to differentiate postsurgical changes from recurrent disease. We show examples of immune related inflammatory effects visualised on FDG PET/CT that should not be misinterpreted as malignant in aetiology. Although not directly an immunotherapy like CTLA-4 or PD-1 pathway blockade, features of an immune-related inflammatory response such as reactive nodal activity or diffuse splenic activity are also seen with BRAF inhibitors. We also highlight how early identification of metastatic melanoma with imaging may not change survival but cause morbidity from consequences of additional interventions. In the setting of oligometastatic disease, a short period of observation with repeat imaging to ascertain rate of temporal change and metastatic progression can be a useful approach to reduce futile interventions. With availability of newer therapies, however, the treatment landscape continues to evolve.
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Uren RF, Howman-Giles R, Thompson JF. Lymphatic drainage from the skin of the back to retroperitoneal and paravertebral lymph nodes in melanoma patients. Ann Surg Oncol. 1998;5(4):384–7.
Unal K, Unlu M, Akdemir O, Akmansu M. 18F-FDG PET/CT findings of radiotherapy-related myocardial changes in patients with thoracic malignancies. Nucl Med Commun. 2013;34(9):855–9. doi:10.1097/MNM.0b013e328362f824.
Hofman MS, Hicks RJ. How we read oncologic FDG PET/CT. Cancer Imaging. 2016;16(1):35. Review. PubMed PMID: 27756360; PubMed Central PMCID: PMC5067887.
Wong ANM, McArthur GA, Hofman MS, Hicks RJ. The Advantages and Challenges of Using FDG PET/CT for Response Assessment in Melanoma in the Era of Targeted Agents and Immunotherapy. European Journal of Nuclear Medicine and Molecular Imaging.
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Hofman, M.S., Hicks, R.J. (2017). PET/CT in Melanoma (Additional Teaching Cases). In: Hofman, M., Hicks, R. (eds) PET/CT in Melanoma. Clinicians’ Guides to Radionuclide Hybrid Imaging(). Springer, Cham. https://doi.org/10.1007/978-3-319-54741-1_6
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DOI: https://doi.org/10.1007/978-3-319-54741-1_6
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