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Nuclear Oncology pp 1065–1102Cite as

Diagnostic Applications of Nuclear Medicine: Malignant Melanoma

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Abstract

Malignant melanoma was diagnosed in approximately 74,000 patients in 2015 in the USA. Melanoma accounts for about 3% of all skin cancers. Major parameters that impact prognosis include Breslow thickness, ulceration, tumor location, growth pattern, histological subtype, patient’s age, gender, and tumor status of regional lymph nodes. Melanomas are staged using the American Joint Committee on Cancer (AJCC) TNM system, which has incorporated the histological status of SLN into its latest staging system version of cutaneous malignant melanoma.

In early stage melanoma (AJCC I–II), sentinel lymph node biopsy (SLNB) is the standard of care for nodal staging. Lymphoscintigraphy with SPECT/CT improves the detection of SLN. In AJCC stage I–II melanoma, [18F]FDG PET/CT has poor sensitivity for the detection of nodal metastases but it is sensitive for the detection of distant metastases. In patients with AJCC stage III (regional nodal involvement) or stage IV disease (systemic metastases), [18F]FDG PET/CT is useful to identify metastatic disease. PET imaging in melanoma patients should include the arms and legs, especially in patients whose primary lesions arise on extremities. False-negative results can occur with small skin and brain metastases, and lesions adjacent to the heart, kidneys, or urinary bladder.

Although [18F]FDG PET/CT is more specific in the diagnosis of melanoma pulmonary metastases, chest CT is more sensitive. Most PET false negatives in recurrent disease are typically less than 1 cm in diameter and are mainly pulmonary and hepatic in location, or in the brain. [18F]FDG PET/CT is useful in treatment monitoring of metastatic melanoma and in posttherapy surveillance.

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Abbreviations

[18F]FDG:

2-Deoxy-2-[18F]fluoro-d-glucose

18F-FLT:

3′-18F-fluoro-3′-deoxythymidine

AJCC:

American Joint Committee on Cancer

APC:

Antigen-presenting cell

bFGF:

Basic fibroblast growth factor

BRAF:

RAF serine-/threonine-specific protein kinase

Breslow thickness:

A prognostic factor in cutaneous melanoma, based on description of how deeply tumor cells have invaded the skin (also called “Breslow depth”)

c-KIT:

A proto-oncogene encoding for tyrosine-protein kinase Kit (or CD117), also known as mast/stem cell growth factor receptor (SCFR)

CDK4:

Cyclin-dependent kinase 4

CDKN2A:

Cyclin-dependent kinase inhibitor 2A

ceCT:

Contrast-enhanced computed tomography

CI:

Confidence interval

Clark level:

A staging system for cutaneous melanoma based on description of the level of anatomic invasion of the melanoma in the skin (generally used in conjunction with Breslow’s depth)

COT:

A mitogen-activated protein serine/threonine kinase involved in T-cell activation

CR:

Complete response

CT:

X-ray computed tomography

ERK:

Extracellular signal-regulated kinase

FDA:

United States Food and Drug Administration

GLUT:

Glucose transporter family

HR:

Hazard ratio, a statistical parameter used in survival analysis

IDO:

Indoleamine 2,3-dioxygenase

IFN:

Interferon

IGFR1:

Insulin-like growth factor 1

LAG-3:

Lymphocyte-activation gene 3

LDH:

Lactate dehydrogenase

LS:

Lymphoscintigraphy

M:

Metastasis status according to the AJCC/UICC TNM staging system

MAGE:

Melanoma-associated antigen gene

MAPK:

Mitogen-activated protein kinase

MHC:

Major histocompatibility complex

MRI:

Magnetic resonance imaging

N:

Lymph node status according to the AJCC/UICC TNM staging system

NCCN:

National Comprehensive Cancer Network

NRAS:

Oncogene encoding for a membrane protein that shuttles between the Golgi apparatus and the plasma membrane

ORR:

Overall response rate

OS:

Overall survival

PD-L1:

Programmed death ligand

PDGF:

Platelet-derived growth factor

PET:

Positron emission tomography

PET/CT:

Positron emission tomography/computed tomography

PFS:

Progression-free survival

PFS:

Progression-free survival

PI3K:

Phosphatidylinositol 3-kinase

PlGF:

Placental growth factor

PTEN:

Gene encoding for the phosphatase and tensin homolog protein, a tumor suppressor (PTEN deletions indicate a poor prognosis)

RAF:

Rapidly accelerated fibrosarcoma, related to retroviral oncogenes

RECIST:

Response evaluation criteria in solid tumors

S-100:

A low-molecular-weight calcium-binding protein expressed in melanomas, but also in other benign and malignant conditions

SLN:

Sentinel lymph node

SLNB:

Sentinel lymph node biopsy

SLNE:

Sentinel lymph node excision

SPECT:

Single photon emission computed tomography

SPECT/CT:

Single photon emission computed tomography/computed tomography

SUV:

Standardized uptake value

SUVmax :

Standardized uptake value at point of maximum

T:

Tumor status according to the AJCC/UICC TNM staging system

TGF:

Transforming growth factor

TIM-3:

T-cell immunoglobulin and mucin-domain containing-3

UICC:

Union Internationale Contre le Cancer (International Union Against Cancer)

UV:

Ultraviolet

VEGF:

Vascular endothelial growth factor

WHO:

World Health Organization

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Authors and Affiliations

  1. Olivia Newton-John Cancer Research Institute and La Trobe University, Melbourne, VIC, Australia

    Andrew M. Scott & Sze-Ting Lee

  2. Department of Molecular Imaging and Therapy, Austin Health, Melbourne, VIC, Australia

    Andrew M. Scott & Sze-Ting Lee

  3. Global Clinical Research Oncology, Bristol-Myers Squibb, London, UK

    Marika Ciprotti

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  1. Andrew M. Scott
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  2. Marika Ciprotti
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  3. Sze-Ting Lee
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Correspondence to Andrew M. Scott .

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Editors and Affiliations

  1. Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA

    H. William Strauss

  2. University of Pisa, Regional Center of Nuclear Medicine, Pisa, Italy

    Giuliano Mariani

  3. University of Pisa, Regional Center of Nuclear Medicine, Pisa, Italy

    Duccio Volterrani

  4. Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA

    Steven M. Larson

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Scott, A.M., Ciprotti, M., Lee, ST. (2017). Diagnostic Applications of Nuclear Medicine: Malignant Melanoma. In: Strauss, H., Mariani, G., Volterrani, D., Larson, S. (eds) Nuclear Oncology. Springer, Cham. https://doi.org/10.1007/978-3-319-26236-9_24

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