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Background <p>Melanoma is a lethal skin cancer and accounts for the highest mortality rate caused by cutaneous malignancies. Prognosis is dependent on stage. Patients with “thick” melanomas of 4-mm Breslow depth or greater are at increased risk for nodal metastases. Positron emission tomography/computed tomography (PET/CT) may be an underutilized imaging study for preoperative clinical staging in those with T4 melanoma.</p> Patients and Methods <p>This was a single-institution retrospective analysis of adult patients with biopsy-proven T4 predominantly cutaneous melanoma (&gt; 4 mm tumor thickness) who underwent preoperative PET/CT at a single National Cancer Institute (NCI)-designated cancer center between 1 January 2010 and 30 December 2022. Patients were excluded if there was clinical evidence of locoregional or distant metastatic disease at time of preoperative PET/CT.</p> Results <p>A total of 94 patients met inclusion criteria. They were predominantly male (<i>n</i> = 56, 59.6%) and Caucasian (<i>n</i> = 83, 94.3%) with an average body mass index (BMI) of 27.97 and median age of 69.5 years. A total of 69.7% of patients had tumor ulceration on biopsy and 2% had microsatellitosis. Positive PET/CT scans were found in eight patients (8.5%), which changed clinical management in seven of the eight patients. When comparing PET/CT results to sentinel lymph node biopsy (SLNB) results, sensitivity was 15.4%, specificity was 94.1%, positive predictive value was 50%, and negative predictive value was 74.4%.</p> Conclusions <p>Patients with T4 melanoma without clinical suspicion of nodal disease do not have a high rate of occult metastases on preoperative PET/CT. We argue that clinical exam remains the most important tool for preoperative workup in these patients, but that PET/CT may be considered on the basis of patient-specific factors.</p>

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The Utility of Preoperative PET/CT in Patients with Clinically High-Risk Melanoma

  • 期刊论文

  • 发表日期：

    2025年9月25日

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  • Emily Papai,
  • Kayla Ntoh,
  • Li Zhang,
  • Jian Q. Yu,
  • Anthony J. Olszanski,
  • Anthony M. Villano,
  • Andrea S. Porpiglia,
  • Sanjay S. Reddy,
  • Jeffrey M. Farma,
  • Stephanie H. Greco

摘要

Background

Melanoma is a lethal skin cancer and accounts for the highest mortality rate caused by cutaneous malignancies. Prognosis is dependent on stage. Patients with “thick” melanomas of 4-mm Breslow depth or greater are at increased risk for nodal metastases. Positron emission tomography/computed tomography (PET/CT) may be an underutilized imaging study for preoperative clinical staging in those with T4 melanoma.

Patients and Methods

This was a single-institution retrospective analysis of adult patients with biopsy-proven T4 predominantly cutaneous melanoma (> 4 mm tumor thickness) who underwent preoperative PET/CT at a single National Cancer Institute (NCI)-designated cancer center between 1 January 2010 and 30 December 2022. Patients were excluded if there was clinical evidence of locoregional or distant metastatic disease at time of preoperative PET/CT.

Results

A total of 94 patients met inclusion criteria. They were predominantly male (n = 56, 59.6%) and Caucasian (n = 83, 94.3%) with an average body mass index (BMI) of 27.97 and median age of 69.5 years. A total of 69.7% of patients had tumor ulceration on biopsy and 2% had microsatellitosis. Positive PET/CT scans were found in eight patients (8.5%), which changed clinical management in seven of the eight patients. When comparing PET/CT results to sentinel lymph node biopsy (SLNB) results, sensitivity was 15.4%, specificity was 94.1%, positive predictive value was 50%, and negative predictive value was 74.4%.

Conclusions

Patients with T4 melanoma without clinical suspicion of nodal disease do not have a high rate of occult metastases on preoperative PET/CT. We argue that clinical exam remains the most important tool for preoperative workup in these patients, but that PET/CT may be considered on the basis of patient-specific factors.