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

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.

Key words:

Malignant melanoma - FDG-PET - ganglion - dermatofibroma

Schlüsselwörter:

FDG-PET - malignes Melanom - Ganglion - Dermatofibrom

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