PET Imaging of Melanoma
Journal Title
In: Signore, A. (ed) Nuclear Medicine and Molecular Imaging, Volume 3
Publication Type
Book section
Abstract
Melanoma causes significant morbidity and mortality in much of the developed world, primarily in fair-skinned individuals. At both initial diagnosis and during follow-up, the likelihood of metastatic disease is influenced by pathological features of the primary and impacts the choice of staging investigation. Molecular imaging has a pivotal role in the assessment of melanoma except in the lowest risk clinical settings. Lymphoscintigraphy combined with sentinel lymph node biopsy (SLNB) is now well-established for the evaluation of regional nodes in selected cases. In patients with known metastasis to nodes or limited systemic sites, accurate determination of the extent of disease has become vital, since there are now numerous therapeutic options apart from surgery for locoregional disease. These particularly include targeted agents and immune check point inhibitor (ICI) treatment. Although 67Ga-citrate imaging had a role in molecular imaging of melanoma, as with its use in evaluation of lymphoma, this has been largely supplanted by 18F-fluorodeoxyglucose (FDG) PET/CT due to greater convenience and diagnostic accuracy. Similarly, reflecting more sensitive detection of sites of disease on FDG PET compared to conventional imaging, with the exception of brain and small lung metastases, for which MRI and CT remain preferred diagnostic modalities respectively, FDG PET/CT is increasingly the optimal technique for assessing high-risk melanoma at diagnosis, during therapy and in follow-up after treatment. The major limitations of FDG as a diagnostic agent are its lack of specificity and poor lesion detection in the brain. Niche applications for alternative PET tracers exist in this context. These include melanin-binding agents and various agents to image the tumor microenvironment (TME), including immune cell infiltrates and their function. In this chapter, integration of these various approaches into the diagnostic paradigm are discussed.
Publisher
Elsevier
Keywords
Fluorodeoxyglucose (FDG); Immune checkpoint; Lymphoscintigraphy; Melanin; Melanoma; Positron emission tomography (PET); Sentinel lymph node; Staging; Therapeutic monitoring
Department(s)
Cancer Imaging
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