European Journal of Plastic Surgery

, Volume 40, Issue 1, pp 47–52 | Cite as

Role of FDG-PET/CT in stage 1–4 malignant melanoma patients

  • Mai Eldon
  • Ulrik Knap Kjerkegaard
  • Mette Heisz Ørndrup
  • Pia Sjøgren
  • Lars Bjørn Stolle
Original Paper
First Online:
Received:
Accepted:

Abstract

Background

The number of patients diagnosed with malignant melanoma (MM) has increased over several years. Despite early diagnosis of MM and therefore better prognosis, the number of FDG-PET/CT scans (PET/CT) seems to be increasing. This study aimed to describe all MM patients who were PET/CT scanned in 2012 at a department of plastic surgery and to analyze the pattern of referral and outcome of PET/CT scans of these patients all back from early diagnosis of the patient in the period 2008–2012.

Methods

All patients with MM stages 1–4 (AJCC stages) and melanoma of unknown primary (MUP) who were PET/CT scanned in 2012 were included. This resulted in a study group of 58 patients with 109 PET/CT scans during the study period 2008–2012.

Results

Indications for referring stages 1 and 2 patients to PET/CT were usually based on subjective symptoms of disease, whilst patients in stages 3 and 4 were usually appointed to a PET/CT based on objective, radiological or histological signs of relapse. Approximately, two thirds of the PET/CT scans of stages 1 and 2 patients, respectively, were negative, which is twice as many compared to stages 3–4. Five patients were upgraded in stage because of a biopsy taken after PET/CT. The number of additional examinations triggered per PET/CT increased with the stages.

Conclusions

Some PET/CT scans of stages 1 and 2, MM patients might have been unnecessary considering the vague indications for referral and the relatively large number of negative scans. Earlier, there was no national guideline for the use of PET/CT scans of MM patients. Hopefully, the recently published guideline from The Danish Health Board will help optimize the cost-benefit of each PET/CT scan.

Level of Evidence: Level IV, diagnostic study.

Keywords

Malignant melanoma FDG-PET/CT Melanoma stages Metastasis Sensitivity Specificity 
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Notes

Compliance with ethical standards

Conflict of interest

Mai Eldon, Ulrik Knap Kjerkegaard, Mette Heisz Ørndrup, Pia Sjøgren2, and Lars Bjørn Stolle declare that they have no conflict of interest.

Ethical standards

For this type of study formal consent is not required.

Patient consent

For this type of study informed consent is not required.

Funding

None.

References

  1. 1.
    Erdmann F, Lortet-Tieulent J, Schüz J, et al. (2013) International trends in the incidence of malignant melanoma 1953–2008—are recent generations at higher or lower risk? Int J Cancer 132(2):385–400Google Scholar
  2. 2.
    The Danish Cancer Registry. 2013 report. Available from www.ssi.dk. Accessed 1 Dec 2015.
  3. 3.
    Cho E, Rosner BA, Feskanich D, Colditz GA (2005) Risk factors and individual probabilities of melanoma for whites. J Clin Oncol 23(12):2669–2675CrossRefPubMedGoogle Scholar
  4. 4.
    Sundhedsstyrelsen (2012) Pakkeforløb for modermærkekræft. Available from www.sst.dk. Accessed 1 Dec 2015.
  5. 5.
    Balch CM, Gershenwald JE, Soong SJ, et al. (2009) Final version of 2009 AJCC melanoma staging and classification. J Clin Oncol 27(36):6199–6206Google Scholar
  6. 6.
    Mohr P, Eggermont AM, Hauschild A, Buzaid A (2009) Staging of cutaneous melanoma. Ann Oncol 20(Suppl 6):vi14–vi21CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Ho Shon IA, Chung DK, Saw RP, Thompson JF (2008) Imaging in cutaneous melanoma. Nucl Med Commun 29(10):847–876CrossRefPubMedGoogle Scholar
  8. 8.
    Gao G, Gong B, Shen W (2013) Meta-analysis of the additional value of integrated 18FDG PET-CT for tumor distant metastasis staging: comparison with 18FDG PET alone and CT alone. Surg Oncol 22(3):195–200CrossRefPubMedGoogle Scholar
  9. 9.
    Bourgeois AC, Chang TT, Fish LM, Bradley YC (2013) Positron emission tomography/computed tomography in melanoma. Radiol Clin N Am 51(5):865–879CrossRefPubMedGoogle Scholar
  10. 10.
    Danielsen M, Højgaard L, Kjær A, Fischer BM (2013) Positron emission tomography in the follow-up of cutaneous malignant melanoma patients: a systematic review. Am J Nucl Med Mol Imaging 4(1):17–28PubMedPubMedCentralGoogle Scholar
  11. 11.
    Krug B, Crott R, Lonneux M, Baurain JF, Pirson AS, Vander Borght T (2008) Role of PET in the initial staging of cutaneous malignant melanoma: systematic review. Radiology 249(3):836–844CrossRefPubMedGoogle Scholar
  12. 12.
    Dummer R, Hauschild A, Guggenheim M, Keilholz U, Pentheroudakis G (2012) Cutaneous melanoma: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol 23(Suppl 7):vii86–vii91CrossRefPubMedGoogle Scholar
  13. 13.
    Francken AB, Bastiaannet E, Hoekstra HJ (2005) Follow-up in patients with localized primary cutaneous melanoma. Lancet Oncol 6:608–621CrossRefPubMedGoogle Scholar
  14. 14.
    Francken AB, Shaw HM, Accortt NA, Soong SJ, Hoekstra HJ, Thompson JF (2007) Detection of first relapse in cutaneous melanoma patients: implications for the formulation of evidence-based follow-up guidelines. Ann Surg Oncol 14:1924–1933CrossRefPubMedGoogle Scholar
  15. 15.
    Francken AB, Accortt NA, Shaw HM, et al. (2008) Follow-up schedules after treatment for malignant melanoma. Br J Surg 95:1401–1407CrossRefPubMedGoogle Scholar
  16. 16.
    Garbe C, Paul A, Kohler-Spath H, et al. (2003) Prospective evaluation of a follow-up schedule in cutaneous melanoma patients: recommendations for an effective follow-up strategy. J Clin Oncol 21:520–529CrossRefPubMedGoogle Scholar
  17. 17.
    Meyers MO, Yeh JJ, Frank J, et al. (2009) Method of detection of initial recurrence of stage II/III cutaneous melanoma: analysis of utility of follow-up staging. Ann Surg Oncol 16:941–947CrossRefPubMedGoogle Scholar
  18. 18.
    Fields RC, Coit DG (2011) Evidence-based follow-up for the patient with melanoma. Surg Oncol Clin N Am 20:181–200CrossRefPubMedGoogle Scholar
  19. 19.
    NCCN Clinical practice guidelines in oncology. Melanoma v.2. 2014.Google Scholar
  20. 20.
    Romano E, Scordo M, Dusza SW, Coit DG, Chapman PB (2010) Site and timing of first relapse in stage III melanoma patients: implications for follow-up guidelines. J Clin Oncol 28:3042–3047CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Xing Y, Cromwell KD, Cormier JN (2012) Review of diagnostic imaging modalities for the surveillance of melanoma patients. Dermatol Res Pract 2012:941921PubMedGoogle Scholar
  22. 22.
    Leiter U, Meier F, Schittek B, Garbe C (2004) The natural course of cutaneous melanoma. J Surg Oncol 86:172–178CrossRefPubMedGoogle Scholar
  23. 23.
    Meier F, Will S, Ellwanger U, Schlagenhauff B, Schittek B, et al. (2002) Metastatic pathways and time courses in the orderly progression of cutaneous melanoma. Br J Dermatol 147:62–70CrossRefPubMedGoogle Scholar
  24. 24.
    Time course and pattern of metastasis of cutaneous melanoma differ between men and women Liljana Mervic Published: March 6, 2012 doi: 10.1371/journal.pone.0032955Google Scholar
  25. 25.
    Xing Y, Bronstein Y, Ross MI, et al. (2011) Contemporary diagnostic imaging modalities for the staging and surveillance of melanoma patients: a meta-analysis. J Natl Cancer Inst 103(2):129–142CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Pflugfelder A, Kochs C, Blum A, et al. (2013) Malignant melanoma S3-guidline “diagnosis, therapy and follow-up of melanoma”. J Dtsch Dermatol Ges 11(Suppl 6):1–126PubMedGoogle Scholar
  27. 27.
    Peric B, Zagar I, Novakovic S, Zgajnar J, Hocevar M (2011) Role of serum S100B and PET-CT in follow-up of patients with cutaneous melanoma. BMC Cancer 11:328CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Ortiz B, Vázquez C, Martínez C, et al. (2003) S100 protein as tumoral marker in melanoma patients. Comparative study with sentinel node biopsy and whole body FDG-PET. Rev Esp Med Nucl 22(2):87–96CrossRefPubMedGoogle Scholar
  29. 29.
    Jury CS, McAllister EJ, MacKie RM (2000) Rising levels of serum S100 protein precede other evidence of disease progression in patients with malignant melanoma. Br J Dermatol 143(2):269–274CrossRefPubMedGoogle Scholar
  30. 30.
    Reinhardt MJ, Kensy J, Frohmann JP, et al. (2002) Value of tumour marker S-100B in melanoma patients: a comparison to 18F-FDG PET and clinical data. Nuklearmedizin 41(3):143–147PubMedGoogle Scholar
  31. 31.
    Petersen H et al (2015) FDG PET/CT in cancer: comparison of actual use with literature-based recommendations. Eur J Nucl Med Mol Imaging. 2015 Oct 30.Google Scholar
  32. 32.
  33. 33.
    National Cancer Intelligence Network. . Available from http://www.ncin.org.uk/publications/survival_by_stage Accessed 1 Apr 2016.
  34. 34.
    Sundhedsstyrelsen (2015) Opfølgningsprogram for Modermærkekræft (Melanom). Available from www.sst.dk. Accessed 1 Dec 2015.

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  1. 1.Department of DermatologyAarhus University HospitalAarhus CDenmark
  2. 2.Department of Plastic SurgeryOdense University HospitalOdense CDenmark
  3. 3.Department of Plastic SurgeryAarhus University HospitalAarhus CDenmark

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