Impact of [18F]fluorodeoxyglucose positron emission tomography on surgical management of melanoma patients

Background: Several studies have shown adequate sensitivity and specificity of [F-18]fluorodeoxyglucose positron emission tomography (FDG-PET) for the detection of metastases from melanoma, but few have addressed its impact on treatment. The aim of this retrospective study was to assess the impact of FDG-PET on treatment of melanoma in three Dutch university medical centres. Methods: The medical records of 257 patients were reviewed. The indications for FDG-PET and findings were recorded. Unexpected findings of suspected (pre)malignant tumours other than melanoma were assessed. Treatment plans before and after FDG-PET were recorded and analysed to evaluate changes in disease management. Results: Most scans (71(.)2 per cent) were requested for staging, mainly to detect distant metastases in patients with stage III disease. Overall, 56 patients (21(.)8 per cent) were upstaged as a result of PET. In 44 patients (17(.)1 percent) treatment was changed, usually from surgery to systemic treatment m patients with stage III disease. Unexpected tumours were detected (mainly colorectal) in 11 patients (4(.)3 per cent). Conclusion: FDG-PET is most valuable in patients with stage III melanoma for detection of distant metastases and identification of candidates for surgery and/or systemic treatment. Unexpected FDG-PET findings should not be disregarded, as (pre)malignant, clinically relevant, tumours may be identified.