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Follow-up of primary melanoma patients with high risk of recurrence: recommendations based on evidence and consensus. Clin Transl Oncol 2022; 24:1515-1523. [PMID: 35349041 DOI: 10.1007/s12094-022-02822-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 02/27/2022] [Indexed: 10/18/2022]
Abstract
In spite of the good prognosis of patients with early-stage melanoma, there is a substantial proportion of them that develop local or distant relapses. With the introduction of targeted and immune therapies for advanced melanoma, including at the adjuvant setting, early detection of recurrent melanoma and/or second primary lesions is crucial to improve clinical outcomes. However, there is a lack of universal guidelines regarding both frequency of surveillance visits and diagnostic imaging and/or laboratory evaluations. In this article, a multidisciplinary expert panel recommends, after careful review of relevant data in the field, a consensus- and experience-based follow-up strategy for melanoma patients, taking into account prognostic factors and biomarkers and the high-risk periods and patterns of recurrence in each (sub) stage of the disease. Apart from the surveillance intensity, healthcare professionals should focus on patients' education to perform regular self-examinations of the skin and palpation of lymph nodes.
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Kudura K, Dimitriou F, Mihic-Probst D, Muehlematter UJ, Kutzker T, Basler L, Förster R, Dummer R, Mangana J, Husmann L, Burger IA, Kreissl MC. Malignancy Rate of Indeterminate Findings on FDG-PET/CT in Cutaneous Melanoma Patients. Diagnostics (Basel) 2021; 11:diagnostics11050883. [PMID: 34063555 PMCID: PMC8156636 DOI: 10.3390/diagnostics11050883] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 05/09/2021] [Accepted: 05/12/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The use of 18F-2-Fluor-2-desoxy-D-glucose Positron Emission Tomography/Computed Tomography FDG-PET/CT in clinical routine for staging, treatment response monitoring and post treatment surveillance in metastatic melanoma patients has noticeably increased due to significant improvement of the overall survival rate in melanoma patients. However, determining the dignity of the findings with increased metabolic activity on FDG-PET/CT can be sometimes challenging and may need further investigation. PURPOSE We aimed to investigate the malignancy rate of indeterminate findings on FDG-PET/CT in metastatic cutaneous melanoma patients. METHODS This single-center retrospective study included cutaneous melanoma patients who underwent FDG-PET/CT in clinical routine between 2015 and 2017 with findings reported as indeterminate and therefore requiring further evaluation. The dignity of the included findings was determined by subsequent imaging and, if required, additional histopathology. The impact of the outcome on the clinical management was also reported. RESULTS A total of 842 FDG-PET/CT reports of 244 metastatic cutaneous melanoma patients were reviewed. Sixty indeterminate findings were included. Almost half of all indeterminate findings were lymph nodes, lung nodules and cerebral lesions. In total, 43.3% of all included findings proved to be malignant. 81% of all malignant lesions were metastases of cutaneous melanoma, while 19% of all malignant lesions could be attributed to other primary malignancies, such as lung, breast, thyroid and colorectal cancers. Malignant findings influenced clinical management in 60% of the cases. CONCLUSION Indeterminate findings on FDG-PET/CT in metastatic cutaneous melanoma patients should be further investigated. Almost one out of every two indeterminate findings on FDG-PET/CT is malignant. The majority of the findings are melanoma manifestations, however, in a significant percentage, other primary tumors are found. Upon verification, patient management is changed in most cases.
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Affiliation(s)
- Ken Kudura
- Department of Nuclear Medicine, University Hospital Zurich, 8006 Zurich, Switzerland; (U.J.M.); (L.H.); (I.A.B.)
- Faculty of Medicine, University of Zurich, 8091 Zurich, Switzerland; (F.D.); (D.M.-P.); (L.B.); (R.F.); (R.D.); (J.M.)
- Correspondence:
| | - Florentia Dimitriou
- Faculty of Medicine, University of Zurich, 8091 Zurich, Switzerland; (F.D.); (D.M.-P.); (L.B.); (R.F.); (R.D.); (J.M.)
- Department of Dermatology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Daniela Mihic-Probst
- Faculty of Medicine, University of Zurich, 8091 Zurich, Switzerland; (F.D.); (D.M.-P.); (L.B.); (R.F.); (R.D.); (J.M.)
- Institute of Pathology and Molecular Pathology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Urs J. Muehlematter
- Department of Nuclear Medicine, University Hospital Zurich, 8006 Zurich, Switzerland; (U.J.M.); (L.H.); (I.A.B.)
- Faculty of Medicine, University of Zurich, 8091 Zurich, Switzerland; (F.D.); (D.M.-P.); (L.B.); (R.F.); (R.D.); (J.M.)
| | - Tim Kutzker
- Faculty of Applied Statistics, Humboldt University Berlin, 10117 Berlin, Germany;
| | - Lucas Basler
- Faculty of Medicine, University of Zurich, 8091 Zurich, Switzerland; (F.D.); (D.M.-P.); (L.B.); (R.F.); (R.D.); (J.M.)
- Center for Proton Therapy, Paul Scherrer Institute, 5232 Villigen, Switzerland
| | - Robert Förster
- Faculty of Medicine, University of Zurich, 8091 Zurich, Switzerland; (F.D.); (D.M.-P.); (L.B.); (R.F.); (R.D.); (J.M.)
- Institute of Radiation Oncology, Cantonal Hospital Winterthur, 8400 Winterthur, Switzerland
| | - Reinhard Dummer
- Faculty of Medicine, University of Zurich, 8091 Zurich, Switzerland; (F.D.); (D.M.-P.); (L.B.); (R.F.); (R.D.); (J.M.)
- Department of Dermatology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Joanna Mangana
- Faculty of Medicine, University of Zurich, 8091 Zurich, Switzerland; (F.D.); (D.M.-P.); (L.B.); (R.F.); (R.D.); (J.M.)
- Department of Dermatology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Lars Husmann
- Department of Nuclear Medicine, University Hospital Zurich, 8006 Zurich, Switzerland; (U.J.M.); (L.H.); (I.A.B.)
- Faculty of Medicine, University of Zurich, 8091 Zurich, Switzerland; (F.D.); (D.M.-P.); (L.B.); (R.F.); (R.D.); (J.M.)
| | - Irene A. Burger
- Department of Nuclear Medicine, University Hospital Zurich, 8006 Zurich, Switzerland; (U.J.M.); (L.H.); (I.A.B.)
- Faculty of Medicine, University of Zurich, 8091 Zurich, Switzerland; (F.D.); (D.M.-P.); (L.B.); (R.F.); (R.D.); (J.M.)
| | - Michael Christoph Kreissl
- Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, 39120 Magdeburg, Germany;
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El-Shourbagy KH, Mashaly EM, Khodair SA, Houseni MM, Abou Khadrah RS. PET/CT in restaging, prognosis, and recurrence in patients with malignant melanoma. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2020. [DOI: 10.1186/s43055-020-00276-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Cutaneous malignant melanoma (CMM) is a highly aggressive tumor with high tendency of return despite complete surgical removal. It has a high risk of dissemination to regional lymph nodes and visceral organs. The prognosis is highly dependent on lymph node involvement and distant metastases. Positron Emission Tomography with Computed Tomography (PET/CT) is a valuable non-invasive tool for the diagnosis and staging of patients with MM. The purpose of the present study was to evaluate the role of integrated (PET/CT) in staging, restaging, prognosis, and prediction of recurrence in patients with malignant melanoma.
Results
Fifty malignant melanoma patients with age ranged from 28 to74 years (mean age 55.94 + 13.40 years) were 28 males (mean age 56.71 + 12.82) and 22 females (mean age 54.95 + 14.34). All our patients were histopathologically proven to have malignant melanoma. Twenty-one patients came for initial staging by 18F-FDG PET/CT. Their findings were compared with the reference standards and showed the sensitivity of 93.33%, specificity of 60%, and accuracy of 85.71% for primary staging. 18F-FDG PET/CT scan in 11 clinical suspicion patients of relapse after treatment showed the sensitivity of 100%, specificity of 66.66%, positive predictive value of 88.88%; negative predictive value of 100%; and accuracy of 90.90%. FDG-PET/CT of whole body scan in 18 cases of stage IV melanoma showed sensitivity of 100%, specificity of 66.66%, and overall accuracy of 94.44% for detection of distant metastases. SUVmean and SUVmax in all studied groups were significantly higher in true positive more than true negative or false-positive patients diagnosed by PET/CT with high sensitivity (82.88–100%).
Conclusion
PET/CT imaging enhanced diagnostic performance in detection of the primary malignancy, in follow-up of high-risk patients and patients with suspected or known local or distant recurrence, and in restaging of patients with known distant metastatic disease to assess tumor response.
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