Nuklearmedizin 2003; 42(04): 167-172
DOI: 10.1055/s-0038-1625186
Original Article
Schattauer GmbH

Malignant melanoma and 18F-FDG-PET: Should the whole body scan include the legs?

18F-FDG-PET-Ganzkörperscan beim malignen Melanom: Optimierung der Scanlänge
M. Löffler
1   Department of Nuclear Medicine (Head: Univ.-Prof. O. Schober, M. D., Ph. D.)
,
M. Weckesser
1   Department of Nuclear Medicine (Head: Univ.-Prof. O. Schober, M. D., Ph. D.)
,
Ch. Franzius
1   Department of Nuclear Medicine (Head: Univ.-Prof. O. Schober, M. D., Ph. D.)
,
D. Nashan
2   Department of Dermatology (Head: Univ.-Prof. T. A. Luger, M. D.), Münster University, Münster, Germany
,
O. Schober
1   Department of Nuclear Medicine (Head: Univ.-Prof. O. Schober, M. D., Ph. D.)
› Author Affiliations
Further Information

Publication History

Received: 21 February 2003

in revised form: 06 May 2003

Publication Date:
10 January 2018 (online)

Summary:

Aim: 18F-FDG-PET (FDG-PET) is established in staging and follow-up of malignant melanoma. The legs are affected in 10-40% at time of diagnosis even if the primary is at the arms and torso. Imaging including the legs may detect distant manifestations but increases duration of the scan by ~30 min. We intended to disclose the diagnostic benefit of scanning the legs and to evaluate the therapeutic benefit resulting. Patients, Methods: In this retrospective analyse 213 consecutive PET studies of 153 patients with suspected or recent malignant melanoma were re-evaluated for metastastic spread by a blinded investigator. Histopathological follow-up was assessed for confirmation. Results: Suspicious findings at the legs were depicted in 53 patients on 76 occasions. 38/53 showed pathologic uptake in the torso as well. In 15/53 patients it was restricted to the legs. One of them had a hitherto unknown, clinically relevant finding that was not apparent in palpation and inspection. In 6 other patients with primary location at the legs a validation of the positive PET findings was not possible up to now. Conclusion: Metastases and local recurrence of malignant melanoma at the legs were found in 41% of women and 27% of men. However, a long scan does not yield relevant additional data. We found isolated new manifestations at the legs in only 1/153 patients. We recommend performing a long scan only in patients with previous melanoma manifestations restricted to the legs. In all other cases a short scan of the torso and proximal thighs is sufficient. This allows a higher number of PET-scans without loss of diagnostic power and a shorter examination time.

Zusammenfassung:

Ziel: 18F-FDG-PET (FDG-PET) ist in Staging und Nachsorge des malignen Melanoms etabliert. Die Beine sind bei Diagnosestellung zu 10-40% betroffen. Da Metastasierung zudem die Beine betreffen kann, könnten sie in die Bildgebung einzubeziehen sein. Der Scan dauert dann 30 min länger. Wir untersuchten den diagnostischen Zugewinn durch Miterfassung der Beine und dessen therapeutische Relevanz. Methoden: In dieser retrospektiven Analyse wurden 213 konsekutive Untersuchungen an insgesamt 153 Patienten mit bekanntem oder vermutetem malignen Melanom retrospektiv geblindet ausgewertet, Mehrfachuntersuchungen wurden im Mindestab-stand von 3 Monaten durchgeführt. Klinische und pathologische Informationen dienten der Bestätigung suspekter Befunde. Ergebnisse: 53 Patienten zeigten in 76 Untersuchungen eine pathologische FDG-Aufnahme in den Beinen. 38/53 hatten daneben suspekte Foci im Rumpf. 15/53 wiesen nur Manifestationen an den Beinen auf. Nur einer dieser Patienten hatte eine bislang unbekannte, klinisch relevante Metastase. Bei 6 der 11 Patienten mit bekanntem Beinbefall konnten die positiven PET-Befunde bisher nicht ausreichend validiert werden. Schlussfolgerungen: Manifestationen des Melanoms an den Beinen traten bei 41% der Frauen und 27% der Männer auf. Nur 1/153 Patienten zeigte einen zusätzlichen, klinisch relevanten Befund. Liegt klinisch ein ehemaliger Melanombefund nur der Beine vor, so sollten – aus unserer Sicht – diese in der PET auch erfasst werden. In allen anderen Fällen erscheint der PET-Scan vom Rumpf bis zum proximalen Oberschenkel ausreichend. Durch Verkürzung des Messprotokolls kann die Gesamtzahl der PET-Scans bei gleicher klinischer Aussagekraft erhöht werden; zusätzlich wird die Scan-Zeit verkürzt.

 
  • References

  • 1 Acland KM, Healy C, Calonje E. et al. Comparison of positron emission tomography scanning and sentinel node biopsy in the detection of micrometastases of primary cutaneous malignant melanoma. J Clin Oncol 2001; 19: 2674-8.
  • 2 Amer MH, Al-Sarraf M, Vaitkevicius VK. Clinical presentation, natural history and prognostic factors in advanced malignant melanoma. Surg Gynecol Obstet 1979; 149: 687-92.
  • 3 Balch CM, Buzaid AC, Soong SJ. et al. Final version of the American Joint Committee on Cancer staging system for cutaneous melanoma. J Clin Oncol 2001; 19: 3635-48.
  • 4 Balch CM, Soong SJ, Murad TM. et al. A multi-factorial analysis of melanoma. IV. Prognostic factors in 200 melanoma patients with distant metastases (stage III). J Clin Oncol 1983; 1: 126-34.
  • 5 Day Jr CL, Harrist TJ, Gorstein F. et al. Malignant melanoma. Prognostic significance of “microscopic satellites” in the reticular dermis and subcutaneous fat. Ann Surg 1981; 194: 108-12.
  • 6 Dietlein M, Krug B, Groth W. et al. Positron emission tomography using 18F-fluorodeoxyglucose in advanced stages of malignant melanoma: a comparison of ultrasonographic and radiological methods of diagnosis. Nucl Med Commun 1999; 20: 255-61.
  • 7 Dong XD, Tyler D, Johnson JL. et al. Analysis of prognosis and disease progression after local recurrence of melanoma. Cancer 2000; 88: 1063-71.
  • 8 Eggermont AM, ten Hagen TL. Isolated limb perfusion for extremity soft-tissue sarcomas, in-transit metastases, and other unresectable tumors: credits, debits, and future perspectives. Curr Oncol Rep 2001; 3: 359-67.
  • 9 Eigtved A, Andersson AP, Dahlstrom K. et al. Use of fluorine-18 fluorodeoxyglucose positron emission tomography in the detection of silent metastases from malignant melanoma. Eur J Nucl Med 2000; 27: 70-5.
  • 10 Fraker DL. Surgical issues in the management of melanoma. Curr Opin Oncol 1997; 9: 183-8.
  • 11 Harpole Jr DH, Johnson CM, Wolfe WG. et al. Analysis of 945 cases of pulmonary metastatic melanoma. J Thorac Cardiovasc Surg 1992; 103: 743-748 discussion 748-50.
  • 12 Harrist TJ, Rigel DS, Day Jr CL. et al. “Microscopic satellites” are more highly associated with regional lymph node metastases than is primary melanoma thickness. Cancer 1984; 53: 2183-7.
  • 13 Jaques DP, Coit DG, Brennan MF. Major amputation for advanced malignant melanoma. Surg Gynecol Obstet 1989; 169: 1-6.
  • 14 Karakousis CP, Temple DF, Moore R. et al. Prognostic parameters in recurrent malignant melanoma. Cancer 1983; 52: 575-9.
  • 15 Kim SH, Garcia C, Rodriguez J. et al. Prognosis of thick cutaneous melanoma. J Am Coll Surg 1999; 188: 241-7.
  • 16 Klein M, Freedman N, Lotem M. et al. Contribution of whole body F-18-FDG-PET and lymphoscintigraphy to the assessment of regional and distant metastases in cutaneous malignant melanoma. A pilot study. Nuklearmedizin 2000; 39: 56-61.
  • 17 Klop WM, Vrouenraets BC, van Geel BN. et al. Repeat isolated limb perfusion with melphalan for recurrent melanoma of the limbs. J Am Coll Surg 1996; 182: 467-72.
  • 18 Koops HS, Vaglini M, Suciu S. et al. Prophylactic isolated limb perfusion for localized, high-risk limb melanoma: results of a multicenter randomized phase III trial. European Organization for Research and Treatment of Cancer Malignant Melanoma Cooperative Group Protocol 18832, the World Health Organization Melanoma Program Trial 15, and the North American Perfusion Group Southwest Oncology Group-8593. J Clin Oncol 1998; 16: 2906-12.
  • 19 Leo F, Cagini L, Rocmans P. et al. Lung metastases from melanoma: when is surgical treatment warranted?. Br J Cancer 2000; 83: 569-72.
  • 20 Lienard D, Eggermont AM, Kroon BB. et al. Isolated limb perfusion in primary and recurrent melanoma: indications and results. Semin Surg Oncol 1998; 14: 202-9.
  • 21 Lingam MK, Byrne DS, Aitchison T. et al. A single centre’s 10 year experience with isolated limb perfusion in the treatment of recurrent malignant melanoma of the limb. Eur J Cancer 1996; 32A: 1668-73.
  • 22 MacKie RM, Bray CA, Hole DJ. et al. Incidence of and survival from malignant melanoma in Scotland: an epidemiological study. Lancet 2002; 360: 587-91.
  • 23 Reinhardt MJ, Kensy J, Frohmann JP. et al. Value of tumour marker S-100B in melanoma patients: a comparison to 18F-FDG PET and clinical data. Nuklearmedizin 2002; 41: 143-7.
  • 24 Reske SN, Kotzerke J. FDG-PET for clinical use. Results of the 3rd German Interdisciplinary Consensus Conference, “Onko-PET III”, 21 July and 19 September 2000. Eur J Nucl Med 2001; 28: 1707-23.
  • 25 Rinne D, Baum RP, Hor G. et al. Primary staging and follow-up of high risk melanoma patients with whole-body 18F-fluorodeoxyglucose positron emission tomography: results of a prospective study of 100 patients. Cancer 1998; 82: 1664-71.
  • 26 Roses DF, Harris MN, Rigel D. et al. Local and in-transit metastases following definitive excision for primary cutaneous malignant melanoma. Ann Surg 1983; 198: 65-9.
  • 27 Steinert H, Huch-Boni R, Buck A. et al. Malignant melanoma: stating with whole-body PET and FDG. Radiology 1995 1995; 195: 705-9.
  • 28 Wagner JD, Schauwecker D, Davidson D. et al. Prospective study of fluorodeoxyglucose-positron emission tomography imaging of lymph node basins in melanoma patients undergoing sentinel node biopsy. J Clin Oncol 1999; 17: 1508-15.