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Diagnostic Applications of Nuclear Medicine: Malignant Melanoma

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Nuclear Oncology

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Abstract

Malignant melanoma was diagnosed in approximately 74,000 patients in 2015 in the USA. Melanoma accounts for about 3% of all skin cancers. Major parameters that impact prognosis include Breslow thickness, ulceration, tumor location, growth pattern, histological subtype, patient’s age, gender, and tumor status of regional lymph nodes. Melanomas are staged using the American Joint Committee on Cancer (AJCC) TNM system, which has incorporated the histological status of SLN into its latest staging system version of cutaneous malignant melanoma.

In early stage melanoma (AJCC I–II), sentinel lymph node biopsy (SLNB) is the standard of care for nodal staging. Lymphoscintigraphy with SPECT/CT improves the detection of SLN. In AJCC stage I–II melanoma, [18F]FDG PET/CT has poor sensitivity for the detection of nodal metastases but it is sensitive for the detection of distant metastases. In patients with AJCC stage III (regional nodal involvement) or stage IV disease (systemic metastases), [18F]FDG PET/CT is useful to identify metastatic disease. PET imaging in melanoma patients should include the arms and legs, especially in patients whose primary lesions arise on extremities. False-negative results can occur with small skin and brain metastases, and lesions adjacent to the heart, kidneys, or urinary bladder.

Although [18F]FDG PET/CT is more specific in the diagnosis of melanoma pulmonary metastases, chest CT is more sensitive. Most PET false negatives in recurrent disease are typically less than 1 cm in diameter and are mainly pulmonary and hepatic in location or in the brain. [18F]FDG PET/CT is useful in treatment monitoring of metastatic melanoma and in posttherapy surveillance.

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Abbreviations

AJCC:

American Joint Committee on Cancer

APC:

Antigen-presenting cell

bFGF:

Basic fibroblast growth factor

BRAF:

RAF serine−/threonine-specific protein kinase

Breslow thickness:

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

CDK4:

Cyclin-dependent kinase 4

CDKN2A:

Cyclin-dependent kinase inhibitor 2A

ceCT:

Contrast-enhanced computed tomography

CI:

Confidence interval

c-KIT:

A proto-oncogene encoding for tyrosine-protein kinase Kit (or CD117), also known as mast/stem cell growth factor receptor (SCFR)

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)

COT:

A mitogen-activated protein serine/threonine kinase involved in T-cell activation

CR:

Complete response

CT:

X-ray computed tomography

ERK:

Extracellular signal-regulated kinase

[18F]FDG:

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

18F-FLT:

3′-18F-fluoro-3′-deoxythymidine

FDA:

United States Food and Drug Administration

GLUT:

Glucose transporter family

HR:

Hazard ratio, a statistical parameter used in survival analysis

IDO:

Indoleamine 2,3-dioxygenase

IFN:

Interferon

IGFR1:

Insulin-like growth factor 1

LAG-3:

Lymphocyte-activation gene 3

LDH:

Lactate dehydrogenase

LS:

Lymphoscintigraphy

M:

Metastasis status according to the AJCC/UICC TNM staging system

MAGE:

Melanoma-associated antigen gene

MAPK:

Mitogen-activated protein kinase

MHC:

Major histocompatibility complex

MIP:

Maximum Intensity Projection PET image

MRI:

Magnetic resonance imaging

N:

Lymph node status according to the AJCC/UICC TNM staging system

NCCN:

National Comprehensive Cancer Network

NRAS:

Oncogene encoding for a membrane protein that shuttles between the Golgi apparatus and the plasma membrane

ORR:

Overall response rate

OS:

Overall survival

PDGF:

Platelet-derived growth factor

PD-L1:

Programmed death ligand

PET:

Positron emission tomography

PET/CT:

Positron emission tomography/computed tomography

PFS:

Progression-free survival

PI3K:

Phosphatidylinositol 3-kinase

PlGF:

Placental growth factor

PTEN:

Gene encoding for the phosphatase and tensin homolog protein, a tumor suppressor (PTEN deletions indicate a poor prognosis)

RAF:

Rapidly accelerated fibrosarcoma, related to retroviral oncogenes

RECIST:

Response evaluation criteria in solid tumors

S-100:

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

SLN:

Sentinel lymph node

SLNB:

Sentinel lymph node biopsy

SLNE:

Sentinel lymph node excision

SPECT:

Single photon emission computed tomography

SPECT/CT:

Single photon emission computed tomography/computed tomography

SUV:

Standardized uptake value

SUVmax:

Standardized uptake value at point of maximum

T:

Tumor status according to the AJCC/UICC TNM staging system

TGF:

Transforming growth factor

TIM-3:

T-cell immunoglobulin and mucin-domain containing-3

UICC:

Union Internationale Contre le Cancer (International Union Against Cancer)

UV:

Ultraviolet

VEGF:

Vascular endothelial growth factor

WHO:

World Health Organization

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Authors and Affiliations

  1. Department of Molecular Imaging and Therapy, Austin Health, Heidelberg, VIC, Australia

    Andrew M. Scott

  2. Faculty of Medicine, University of Melbourne, Parkville, VIC, Australia

    Andrew M. Scott

  3. Olivia Newton-John Cancer Research Institute, La Trobe University, Heidelberg, VIC, Australia

    Andrew M. Scott

  4. Department of Medical Oncology, Olivia Newton-John Cancer Center, Austin Hospital, Heidelberg, VIC, Australia

    Clare Senko

  5. Janssen Research & Development, Beerse, Belgium

    Marika Ciprotti

  6. Department of Medical Oncology, Austin Health, Heidelberg, VIC, Australia

    She-Ting Lee & Damien Kee

  7. Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

    She-Ting Lee & Damien Kee

  8. Division of Cancer Biology and Stem Cells, Walter Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia

    She-Ting Lee & Damien Kee

  9. Cancer Immunobiology Program, Olivia Newton-John Cancer Research Institute, Heidelberg, VIC, Australia

    She-Ting Lee & Damien Kee

Authors
  1. Andrew M. Scott
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  2. She-Ting Lee
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  3. Clare Senko
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  4. Marika Ciprotti
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  5. Damien Kee
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Correspondence to Andrew M. Scott .

Editor information

Editors and Affiliations

  1. Nuclear Medicine Unit Department of Translational Research and Advanced Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy

    Duccio Volterrani

  2. Nuclear Medicine Unit Department of Translational Research and Advanced Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy

    Paola A. Erba

  3. Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    H. William Strauss

  4. Nuclear Medicine Unit Department of Translational Research and Advanced Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy

    Giuliano Mariani

  5. Molecular Imaging and Targeted Therapy Service Department of Radiology, Sloan Kettering Institute, New York, NY, USA

    Steven M. Larson

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Scott, A.M., Lee, ST., Senko, C., Ciprotti, M., Kee, D. (2022). Diagnostic Applications of Nuclear Medicine: Malignant Melanoma. In: Volterrani, D., Erba, P.A., Strauss, H.W., Mariani, G., Larson, S.M. (eds) Nuclear Oncology. Springer, Cham. https://doi.org/10.1007/978-3-031-05494-5_24

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  • DOI: https://doi.org/10.1007/978-3-031-05494-5_24

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