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Radioguided Surgery for Malignant Melanoma

Nuclear Oncology

  • 19 Accesses

Abstract

Melanoma is one of the most aggressive and therapy-resistant cancers and its incidence is continuously increasing worldwide. The metastatic involvement of lymph nodes is of utmost importance for prognosis in patients with intermediate-thickness melanoma. Other prognostic factors include tumor thickness, presence of ulceration, and mitotic rate.

Radioguided surgery has a prominent role in melanoma, since the sentinel lymph node (SLN) approach in this malignancy constituted not only the first modern clinical application of this procedure in oncology, but it also provided the first groundbreaking evidence for the current SLN concept. The SLN approach is nowadays a pivotal procedure for regional lymphatic staging of these patients. SLN biopsy sensitivity is higher than that of PET/CT for the detection of clinically occult lymphatic metastases in early stages of the disease.

Originally validated for melanoma lesions with intermediate Breslow thickness (1–4 mm), currently SLN biopsy is also recommended for lesions from 0.8 to1 mm thickness if ulceration is present. The procedure can also be considered for thicker melanomas (>4 mm). The SLN approach involves a preoperative lymphoscintigraphy and the intraoperative use of a handheld gamma probe and vital dyes. Presurgical lymphoscintigraphy constitutes the “roadmap” for guiding surgeons toward draining lymph nodes potentially harboring metastasis and is extremely useful for identifying unpredictable drainage patterns that otherwise would be unnoticed. The integration of SPECT/CT in standard gamma cameras led to incorporate this modality to the SLN procedure, thus providing essential anatomic information to surgically localize SLNs. New tracers are now available and new intraoperative devices can be added to conventional instrumentation. Recent trials have shown no melanoma-specific survival benefits between immediate regional lymphadenectomy and active ultrasound surveillance in the case of metastatic SLNs. In this scenario, SLN mapping has become crucial to assess which lymph node basins at risk need to be evaluated during follow-up. New developments in radioguided surgery aim to mark and help to excise oligometastatic foci.

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Abbreviations

[18F]FDG:

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

AJCC:

American Joint Committee on Cancer

Bq:

Becquerel unit

Breslow thickness:

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

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)

CT:

X-ray computed tomography

eV:

Electron volt

FDA:

United States Food and Drug Administration

GOSTT:

Guided intraoperative scintigraphic tumor targeting

HMB-45:

Homatropine methylbromide 45, a monoclonal antibody that reacts against an antigen present in melanomas

ICG:

Indocyanine green

keV:

Kiloelectron volt (103 eV)

MART-1:

Melanoma antigen recognized by T cells 1, also known as Melan A

MBq:

Mega-Becquerel (106 Becquerel)

MRI:

Magnetic resonance imaging

MSS:

Melanoma-specific survival

NCCN:

National Comprehensive Cancer Network

NIR:

Near-infrared

PCR:

Polymerase chain reaction

PET:

Positron emission tomography

PET/CT:

Positron emission tomography/computed tomography

ROLL:

Radioguided occult lesion localization

S-100:

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

SLN:

Sentinel lymph node

SLN biopsy:

Sentinel lymph node biopsy

SPECT:

Single-photon emission computed tomography

SPECT/CT:

Single-photon emission computed tomography/computed tomography

US:

Ultrasonography

UV:

Ultraviolet

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Authors and Affiliations

  1. Nuclear Medicine Department, Hospital Clínic Barcelona, Barcelona, Catalonia, Spain

    Sergi Vidal-Sicart

  2. Institut d’Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Barcelona, Spain

    Sergi Vidal-Sicart

  3. Nuclear Medicine Unit, “Maggiore della Carità” University Hospital, Novara, Italy

    Federica Orsini

  4. Nuclear Medicine and Diagnostic Imaging Section, Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria

    Francesco Giammarile

  5. Centre Léon Bérard, Lyon, France

    Francesco Giammarile

  6. Regional Center of Nuclear Medicine, Department of Translational Research and Advanced Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy

    Giuliano Mariani

  7. Nuclear Medicine Section and Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands

    Renato A. Valdés Olmos

  8. Nuclear Medicine Unit; Department of Medical Sciences, University Hospital of Siena, Siena, Italy

    Federica Orsini

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  1. Sergi Vidal-Sicart
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  2. Federica Orsini
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  3. Francesco Giammarile
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  4. Giuliano Mariani
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  5. Renato A. Valdés Olmos
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Correspondence to Sergi Vidal-Sicart .

Editor information

Editors and Affiliations

  1. Associate Professor and Director of Nuclear Medicine, University of Pisa, Pisa, Italy

    Duccio Volterrani

  2. Translational Research, Pisa University, PISA, Pisa, Italy

    Paola A. Erba

  3. Attending Emeritus, Memorial Sloan-Kettering Cancer Center Dept. Radiology, New York, NY, USA

    H. William Strauss

  4. Professor Emeritus, University of Pisa, Pisa, Italy

    Giuliano Mariani

  5. Attending Physician, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    Steven M. Larson

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Vidal-Sicart, S., Orsini, F., Giammarile, F., Mariani, G., Valdés Olmos, R.A. (2022). Radioguided Surgery for Malignant Melanoma. In: Volterrani, D., Erba, P.A., Strauss, H.W., Mariani, G., Larson, S.M. (eds) Nuclear Oncology. Springer, Cham. https://doi.org/10.1007/978-3-319-26067-9_53-2

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  • DOI: https://doi.org/10.1007/978-3-319-26067-9_53-2

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-26067-9

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  1. Latest

    Radioguided Surgery for Malignant Melanoma
    Published:
    11 June 2022

    DOI: https://doi.org/10.1007/978-3-319-26067-9_53-3

  2. Radioguided Surgery for Malignant Melanoma
    Published:
    02 April 2022

    DOI: https://doi.org/10.1007/978-3-319-26067-9_53-2

  3. Original

    Radioguided Surgery for Malignant Melanoma
    Published:
    27 September 2016

    DOI: https://doi.org/10.1007/978-3-319-26067-9_53-1

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