| 3. Blum A, Schmid-Wendtner MH, Mauss-Kiefer V, Eberle JY, Kuchelmeister C, Dill-Muller D. Ultrasound mapping of lymph node and subcutaneous metastases in patients with cutaneous melanoma: results of a prospective multicenter study. Dermatology. 212(1):47-52, 2006. |
Observational-Dx |
53 patients |
To evaluate the distribution of metastases during follow-up in the draining lymph node areas from the scar of primary to regional lymph nodes (head and neck, supraclavicular, axilla, infraclavicular, groin) in patients with cutaneous melanoma with or without sentinel lymph node biopsy (SLNB) or former elective or consecutive complete lymph node dissection in case of positive sentinel lymph node (CLND). |
Especially in the axilla, infraclavicular region and groin the metastases were not limited to the anatomic lymph node regions. In 5 patients (9.4%) (4 of them were in stage IV) lymph node metastases were not located in the corresponding lymph node area. 32 patients without former SLNB had a time range between melanoma excision and lymph node metastases of 31 months (median), 21 patients with SLNB had 18 months (p < 0.005). In 11 patients with positive SLNB the time range was 17 months, in 10 patients with negative SLNB 21 months (p < 0.005); in 32 patients with CLND the time range was 31 months and in 21 patients without CLND 18 months (p<0.005). In thinner melanomas lymph node metastases occurred later (p<0.05). |
3 |
| 19. Liu SH, Chang WC, Kao PF, et al. Lymphoscintigraphy and intraoperative gamma probe-directed sentinel lymph node mapping in patients with malignant melanoma. Journal of the Formosan Medical Association. 103(1):41-6, 2004 Jan. |
Observational-Dx |
36 malignant melanoma patients in clinical stage I and II |
To evaluate the usefulness of sentinel lymph node (SLN) detection by lymphoscintigraphy and excision with intraoperative gamma probe in Taiwanese patients with malignant melanoma. |
A total of 44 SLNs were detected in 36 patients, with a mean of 1.22 SLNs per patient. The SLN detection rate by lymphoscintigraphy was 100%. During surgery, 39 of the 44 SLNs (88.6%) in 33 of 36 patients (91.7%) were identified. SLN metastasis was found in 8 of 39 dissected SLNs (20.5%) or in 8 of 36 patients (22.2%). The SLN metastatic rate in the patients with primary melanoma with Breslow thickness </= 2.0 mm was 10.0% (2/20), and in patients with Breslow thickness > 2.0 mm was 41.7% (5/12). |
4 |
| 20. Vidal M, Vidal-Sicart S, Torrents A, et al. Accuracy and reproducibility of lymphoscintigraphy for sentinel node detection in patients with cutaneous melanoma. Journal of Nuclear Medicine. 53(8):1193-9, 2012 Aug. |
Review/Other-Dx |
68 melanoma patients |
To determine the reproducibility of lymphoscintigraphy performed by different team members following a strict protocol to assess lymphatic drainage and the location and number of sentinel lymph nodes (SLNs). |
All patients showed lymphatic drainage, and in all cases at least 1 sentinel node was identified. In 65 of 68 patients (96%), the findings of the first lymphoscintigraphy study were similar to those of the second. This similarity was also found in the number of sentinel nodes (171 in the first study and 173 in the second). Eighty percent of patients showed 1-3 SLNs in both lymphoscintigraphy studies. The 2 studies differed in 3 patients (4%): 2 melanomas were located on the trunk and 1 on the head and neck. Drainage was visualized to more than 1 lymphatic basin in 19 patients (28%) in the first study versus 18 patients in the second study. |
4 |
| 21. Cecchi R, De Gaudio C, Buralli L, Innocenti S. Lymphatic mapping and sentinel lymph node biopsy in the management of primary cutaneous melanoma: report of a single-centre experience. Tumori. 92(2):113-7, 2006 Mar-Apr. |
Observational-Dx |
111 patients with stage 1-11 AJCC |
Lymphatic mapping and sentinel lymph node biopsy provide important prognostic data in patients with early stage melanoma and are crucial in guiding the management of the tumor. We report our experience with lymphatic mapping and sentinel lymph node biopsy in a group of patients with primary cutaneous melanoma and discuss recent concepts and controversies on its use. |
Sentinel lymph nodes were identified and removed in all patients (detection rate of 100%), and metastases were found in 17 cases (15.3%).The incidence of metastasis in sentinel lymph nodes was 2.1%, 15.9%, 35.2%, and 41.6% for melanomas < or 1.0, 1.01-2.0, 2.01-4.0, and> 4.0 mm in thickness, respectively. Complete lymph node dissection was performed in 15 of 17 patients with positive sentinel lymph nodes, and metastases in non-sentinel lymph nodes were detected in only 2 cases (11.7%). Recurrences were more frequently observed in patients with a positive than in those with negative sentinel lymph node (41.1% vs 5.3% at a median follow-up of 31.5 months, P<0.001). The false-negative rate was 2.1%. |
3 |
| 22. Wong JH, Steinemann S, Yonehara C, et al. Sentinel node staging for cutaneous melanoma in a university-affiliated community care setting. Annals of Surgical Oncology. 7(6):450-5, 2000 Jul. |
Observational-Dx |
79 patients with cutaneous melanoma |
To determine the feasibility of sentinel lymphadenectomy in a university-affiliated private teaching hospital. |
CL was successful in 77 (97%) of 79 patients. A total of 88 lymphatic basins were found to be at risk for metastatic disease by CL. SLND was not successful in the two patients who did not have a successful CL. Sentinel nodes were identified in all but three patients with the remaining 88 lymphatic basins (technical success, 97%). There was one false negative in this group of patients (~1%). |
3 |
| 23. Assam I, Dierck SP, Zhao Y, et al. Evaluation of sentinel lymph node localization in malignant melanoma by preoperative semiconductor gamma camera and planar lymphoscintigraphy. Journal of Applied Clinical Medical Physics. 24(8):e14077, 2023 Aug. |
Observational-Dx |
40 consecutive malignant melanoma patients |
This study evaluates the effectiveness of a small field-of-view, handheld preoperative semiconductor-based gamma camera device CrystalCam (Crystal Photonics GmbH, Berlin, Germany) in localizing SLN in malignant melanoma patients compared to both conventional planar lymphoscintigraphy and hybrid SPECT/CT; where hybrid SPECT/CT was considered the gold standard. |
The results of the phantom study show a good correlation between activity and count-rates for all distances SPECT/CT, CrystalCamm, and planar lymphoscintigraphy detected 69, 58, and 61 SLNs respectively. The concordance rate of 95.65% by the CrystalCam and planar scintigraphy implies both cameras are statistically coequal in preoperative SLN detection of malignant melanoma. For the higher-echelon nodes, SPECT/CT, planar and CrystalCam imaging systems identified 82, 48, and 13 respectively; thus, CrystalCam was statistically inferior to planar imaging. |
3 |
| 24. Nielsen KR, Chakera AH, Hesse B, et al. The diagnostic value of adding dynamic scintigraphy to standard delayed planar imaging for sentinel node identification in melanoma patients. European Journal of Nuclear Medicine & Molecular Imaging. 38(11):1999-2004, 2011 Nov. |
Observational-Dx |
307 patients |
To compare early dynamic imaging combined with delayed static imaging and single photon emission computed tomography (SPECT)/CT with delayed, planar, static imaging alone for sentinel node (SN) identification in melanoma patients. |
A slightly higher number of SNs (mean 0.12/patient) was identified when interpreting only delayed static images compared to combined imaging. In a direct patient-to-patient comparison, the number of SN(s) identified on the combined vs static images only showed moderate agreement (kappa value 0.56). In 38 patients (17%), positive SNs were identified by the combined procedure compared to 35 (16%) by static imaging only. Thus by static imaging only, tumour-positive SNs were not identified in 3 of 38 patients (8%). |
2 |
| 25. Miranda EP, Gertner M, Wall J, et al. Routine imaging of asymptomatic melanoma patients with metastasis to sentinel lymph nodes rarely identifies systemic disease. Archives of Surgery. 139(8):831-6; discussion 836-7, 2004 Aug. |
Review/Other-Dx |
185 patients |
The diagnostic yield of chest radiography; computed tomography (CT) of the chest, abdomen, and pelvis; and CT or magnetic resonance imaging of the brain in the initial evaluation of melanoma with metastasis to sentinel lymph nodes may not identify systemic disease. |
The results of 0.5% of the imaging studies were positive for metastatic disease, 86% were negative, and 14% were indeterminate. Indeterminate results were confirmed to be negative by additional studies ranging from repeated imaging to invasive procedures, including thoracotomy and brain biopsy. The yields are as follows: chest radiography, 0%; chest CT, 0.7%; abdominal and pelvic CT, 0.7%; brain CT, 0%; and brain magnetic resonance imaging, 0%. Only 1 patient (0.5%) had detectable metastatic disease, and he had symptoms of systemic disease at the time of imaging. |
4 |
| 26. Haddad D, Garvey EM, Mihalik L, Pockaj BA, Gray RJ, Wasif N. Preoperative imaging for early-stage cutaneous melanoma: predictors, usage, and utility at a single institution. American Journal of Surgery. 206(6):979-85; discussion 985-6, 2013 Dec. |
Review/Other-Dx |
515 |
Preoperative imaging for early-stage cutaneous melanoma is not recommended by current guidelines. |
Five hundred fifteen studies were performed in 409 of 546 (75%) patients. Chest x-rays was performed in 70% and advanced imaging in 14% (computed tomography imaging, magnetic resonance imaging, ultrasound, and positron-emission computed tomography imaging). No metastatic lesions were identified. A Breslow thickness greater than 4 mm (odds ratio = 6.46 vs <1 mm; 95% confidence interval, 2.07 to 20.15) and male sex (odds ratio = 2.62 vs female; 95% confidence interval, 1.26 to 5.46) were associated with an increased likelihood of advanced imaging. |
4 |
| 27. Vermeeren L, van der Ent FW, Hulsewe KW. Is there an indication for routine chest X-ray in initial staging of melanoma?. Journal of Surgical Research. 166(1):114-9, 2011 Mar. |
Review/Other-Dx |
248 |
To evaluate therapeutic consequences of preoperative staging with Chest X-ray (CXR) in patients with a primary melanoma planned for sentinel node biopsy (SNB). |
CXR was performed in 227 (92%) cases. In 95% of these patients, the CXR showed no metastasis. In 5%, the CXR was inconclusive; all of these CXR results appeared to be false-positive after complementary radiodiagnostic imaging and/or follow-up. All patients received a SNB. |
4 |
| 28. Garbe C, Amaral T, Peris K, et al. European consensus-based interdisciplinary guideline for melanoma. Part 1: Diagnostics - Update 2024. Eur J Cancer. 2025 Jan 17;215():S0959-8049(24)01759-3. |
Review/Other-Dx |
N/A |
Recommendations for the diagnosis and treatment of melanoma were developed on the basis of systematic literature research and consensus conferences. |
No results stated in abstract. |
4 |
| 29. Sawyer A, McGoldrick RB, Mackey SP, Allan R, Powell B. Does staging computered tomography change management in thick malignant melanoma?. Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS. 62(4):453-6, 2009 Apr. |
Review/Other-Dx |
132 |
To determine whether CT staging changed clinical management at the initial presentation scan and follow up scans. Also we aimed to see whether there was a benefit in performing CT head and neck in staging. |
A total of 488 CT scans were performed on 132 patients (3.7 scans per patient). Initial presentation CT staging scans picked up 1/132 (0.7%) patient with an occult metastases that changed their clinical management. Of the 356 follow up CT staging scans imaging (11/127) 8.6% of patients had metastases detected and clinical management changed. All of these patients exhibited symptoms and signs of clinical metastatic disease. Head metastases are at least as common as other regions such as the chest & abdomen and more common than in the pelvis. Neck CT did not change management. |
4 |
| 30. Barsky M, Cherkassky L, Vezeridis M, Miner TJ. The role of preoperative positron emission tomography/computed tomography (PET/CT) in patients with high-risk melanoma. Journal of Surgical Oncology. 109(7):726-9, 2014 Jun. |
Observational-Dx |
902 |
Positron emission tomography/computed tomography (PET/CT) scanning is commonly used for the preoperative staging of patients with at least intermediate thickness (>1 mm) melanomas. Its role in staging at initial diagnosis for clinically asymptomatic patients is not yet established. |
PET/CT scans were performed for 149 patients with at least an intermediate thickness melanoma. Positive scans were identified in 28% (41/149) of patients. An invasive procedure to further aid in diagnosis was performed in 44% (18), yet only 6 (15%) patients were diagnosed with metastatic cancer (85% false positive rate). Each of these patients had regional disease subsequently diagnosed by a sentinel lymph node biopsy. No distant metastatic disease was identified. |
3 |
| 31. Bikhchandani J, Wood J, Richards AT, Smith RB. No benefit in staging fluorodeoxyglucose-positron emission tomography in clinically node-negative head and neck cutaneous melanoma. Head & Neck. 36(9):1313-6, 2014 Sep. |
Review/Other-Dx |
165 |
Fluorodeoxyglucose-positron emission tomography (FDG-PET) has a high sensitivity for detecting metastasis from melanoma, but its application in early-stage melanomas is questionable. The purpose of this study was to determine if positron emission tomography (PET) is beneficial in staging of clinically node negative (cN0) head and neck melanoma. |
A total of 165 patients were treated; of these, 106 were node negative. FDG-PET was included in initial staging of 47 cN0 patients. None had true distant metastasis detected on PET. The imaging also failed to detect nodal metastasis in 2 patients who had disease on lymphatic sampling. |
4 |
| 32. Ortega-Candil A, Rodriguez-Rey C, Cano-Carrizal R, et al. Breslow thickness and (18)F-FDG PET-CT result in initial staging of cutaneous melanoma: Can a cut-off point be established?. Revista Espanola de Medicina Nuclear e Imagen Molecular. 35(2):96-101, 2016 Mar-Apr. |
Review/Other-Dx |
77 |
To establish a Breslow Thickness (BT) cut-off point for indication of PET-CT of cutaneous melanoma in early stages and evaluate its prognostic value. |
Forty-seven (61.04%) of all 77 patients selected were men, and 11 (14.29%) had a positive PET-CT result. Mean age was 65.17±15.00 years. The median BT in patients with a negative PET-CT result was 2.75 mm (IQR 1.83-4.50) and in the positive group 6.25 mm (IQR 5.40-7.50) (P=.0013). In the ROC curve analysis (AUC 0.804, SE 0.054), an optimal value of 5 mm BT with the following values was obtained: sensitivity 90.91%, specificity 78.79%, negative predictive value (NPV) 98.1%, positive predictive value (PPV) 41.7%, diagnostic OR 37.1, and accuracy 80.52%. Mean follow-up was 18.66±14,35 months, detecting 2/53 (3.77%) deaths in the BT<5 mm group, and 7/24 (29.17%) in the BT=5 mm group. Survival curves between both groups were significantly different (P=.0013). |
4 |
| 33. Cheng D, McNicoll CF, Kirgan D, et al. The role of FDG-PET-CT is limited in initial staging of nodal metastasis for thin cutaneous melanoma. American Journal of Surgery. 221(4):737-740, 2021 04. |
Observational-Dx |
367 patients with cutaneous malignant melanoma |
To determine the ability of PET to detect regional nodal metastases in thin melanomas, who would then benefit from SLNB. |
We identified 367 cases; 95 obtained a PET-CT prior to lymphadenectomy. Overall, sensitivity and specificity of PET-CT was 34.6% and 95.4%, respectively. The positive likelihood ratio and negative likelihood ratio were 7.62 and 0.68, respectively. The accuracy was 78.2%. The positive predictive value for T3 and T4 melanomas were 100% and 81.4%, respectively. For thin melanomas, specificity and accuracy was 88.2% and 88.2%, respectively. |
4 |
| 34. Brady MS, Akhurst T, Spanknebel K, et al. Utility of preoperative [(18)]f fluorodeoxyglucose-positron emission tomography scanning in high-risk melanoma patients. Annals of Surgical Oncology. 13(4):525-32, 2006 Apr. |
Experimental-Dx |
103 |
[(18)]F Fluorodeoxyglucose-positron emission tomography (PET) scanning provides functional imaging based on glucose uptake by tumors. Melanoma is a glucose-avid malignancy, and preoperative PET scanning in melanoma patients has the potential to guide appropriate treatment. |
Preoperative imaging findings led to a change in clinical management in 36 (35%) of 103 patients. In 32 (89%) of these patients, the information was accurate. Findings on PET scan alone (14 of 36; 39%) or in combination with CT (20 of 36; 56%) resulted in a treatment change in most patients (34 of 36; 94%). The most common decision was to cancel the operation (19 of 36; 53%). PET scanning was more sensitive than CT scanning in detecting occult disease (68% vs. 48%; P=.05), but both tests were highly specific (92% vs. 95%; P=.7, PET vs. CT). |
3 |
| 35. Bronstein Y, Ng CS, Rohren E, et al. PET/CT in the management of patients with stage IIIC and IV metastatic melanoma considered candidates for surgery: evaluation of the additive value after conventional imaging. AJR. American Journal of Roentgenology. 198(4):902-8, 2012 Apr. |
Experimental-Dx |
32 |
The purpose of this article is to determine how often unexpected (18)F-FDG PET/CT findings result in a change in management for patients with stage IV and clinically evident stage III melanoma with resectable disease according to conventional imaging. |
PET/CT revealed unexpected melanoma metastases in 12% of scans (4/33). As a result, the surgery was canceled for two patients, and the planned approach was altered for another two patients to address the unexpected sites. In 6% of scans (2/33), the unexpected metastases were detected in the extremities, which were not included in conventional imaging. Three scans (9%) showed false-positive FDG-avid findings that proved to be benign by subsequent stability or resolution with no therapy. |
3 |
| 36. Schule SC, Eigentler TK, Garbe C, la Fougere C, Nikolaou K, Pfannenberg C. Influence of (18)F-FDG PET/CT on therapy management in patients with stage III/IV malignant melanoma. European Journal of Nuclear Medicine & Molecular Imaging. 43(3):482-8, 2016 Mar. |
Observational-Dx |
64 |
To evaluate the influence of (18)F-FDG PET/CT in comparison to CT alone on treatment decisions in patients with advanced melanoma and to analyse the 5-year survival data in comparison to literature data. |
In the 52 patients in the primary staging group, the results of (18)F-FDG PET/CT led to therapy change in 59% and a major therapy change in 52%. (18)F-FDG PET/CT led to the avoidance of futile operations in 13 patients with suspicious lesions on CT that were deemed nontumorous on PET/CT. In the 12 patients in the surveillance group, the results of (18)F-FDG PET/CT led to therapy change in 33% and a major change in 17%. The 5-year survival rates were 30% in the entire cohort, 34% in the primary staging group, and 17% in the surveillance group. A significant overall survival benefit was observed in patients in whom (18)F-FDG PET/CT excluded metastases or in whom metastases could be completely removed compared with patients who were not eligible for surgery (41% vs. 10%). |
3 |
| 37. Aukema TS, Valdes Olmos RA, Wouters MW, et al. Utility of preoperative 18F-FDG PET/CT and brain MRI in melanoma patients with palpable lymph node metastases. Annals of Surgical Oncology. 17(10):2773-8, 2010 Oct. |
Observational-Dx |
70 patients |
To determine the diagnostic value of (18)F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) and brain magnetic resonance imaging (MRI) in melanoma patients with palpable lymph node metastases and to assess the impact of these imaging modalities on their management. |
PET/CT findings changed the intended regional node dissection in 26 patients (37%). PET/CT was false negative in 4 patients (6%) and false positive in 1 (1%). This resulted in a sensitivity of 87%, specificity of 98%, accuracy of 93%, positive predictive value of 96%, and negative predictive value of 91%. MRI revealed brain metastases in 5 patients (7%). The overall survival of patients without additional lesions on PET/CT was 84% after 2 years, which was better than the 56% in patients with additional metastases (P < .001). |
2 |
| 38. Aviles Izquierdo JA, Molina Lopez I, Sobrini Morillo P, Marquez Rodas I, Mercader Cidoncha E. Utility of PET/CT in patients with stage I-III melanoma. Clinical & Translational Oncology: Official Publication of the Federation of Spanish Oncology Societes & of the National Cancer Institute of Mexico. 22(8):1414-1417, 2020 Aug. |
Observational-Dx |
83 patients |
To study the utility of positron emission tomography with computerized tomography (PET/CT) in patients with a stage I-III melanoma. |
Data from 83 patients with a stage I-III melanoma, 39 patients with a positive sentinel lymph node biopsy (SLNB) and 35 patients with locoregional recurrences were analyzed. Sensitivity of PET/CT in clinical stage I-III patients was 5%, with a 14% of false positives. In patients with a positive SLNB, PET/CT previous to complete lymph node dissection had a 23% of false negatives. In patients with clinical locoregional recurrences, PET/CT findings revealed asymptomatic visceral distant metastasis in 25.7%. |
4 |
| 39. Holtkamp LHJ, Chakera AH, Fung S, et al. Staging 18F-FDG PET/CT influences the treatment plan in melanoma patients with satellite or in-transit metastases. Melanoma Research. 30(4):358-363, 2020 08. |
Observational-Dx |
25 patients |
To determine the implications of staging positron emission tomography/computed tomography (PET/CT) and brain magnetic resonance imaging (MRI) for subsequent management of patients with satellite and/or in-transit metastasis (S&ITM) at the time of initial melanoma diagnosis or as a first recurrence, and secondly to establish the diagnostic accuracy of PET/CT and MRI in this population. |
In this prospective study, 25 melanoma patients with a first presentation of S&ITM who had no clinical evidence of palpable nodal or distant metastasis underwent whole-body 18F-FDG PET/CT and brain MRI after a tentative pre-scan treatment plan had been made. Sensitivity and specificity of imaging were determined by pathological confirmation, clinical outcome and repeat PET/CT and MRI at 6 months. PET/CT led to a modification of the initial treatment plan in four patients (16%). All four were upstaged (AJCC stage eighth edition). PET/CT was false-positive in one patient, who had a Schwannoma in his trapezius muscle. A thyroid carcinoma was an incidental finding in another patient. The sensitivity of PET/CT was 58% and specificity 83%. In 6 months following the baseline PET/CT, further sites of in-transit or systemic disease were identified in 10 patients (40%). Brain MRI did not alter the treatment plan or change the disease stage in any patient. Whole-body PET/CT improved staging in melanoma patients with S&ITM and changed the originally-contemplated treatment plan in 16%. MRI of the brain appeared not to be useful. |
3 |
| 40. Niebling MG, Bastiaannet E, Hoekstra OS, Bonenkamp JJ, Koelemij R, Hoekstra HJ. Outcome of clinical stage III melanoma patients with FDG-PET and whole-body CT added to the diagnostic workup. Annals of Surgical Oncology. 20(9):3098-105, 2013 Sep. |
Observational-Tx |
252 |
The aim of this study is to analyze survival of FDG-PET and CT negative or positive melanoma patients and to assess which factors have independent prognostic impact on survival of these patients. |
For all 252 patients 5-year MSS was 38.2%. For FDG-PET and CT negative and positive patients 5-year MSS was 47.6 and 16.9%, respectively. Disease-free period for FDG-PET and CT negative patients was 46.0% after 5 years. Gender, a positive FDG-PET and CT, LNM in axilla compared to head or neck, and presence of extranodal growth were independent factors for worse MSS in all patients. Positive FDG-PET and CT was the most important prognostic factor for MSS with a hazard ratio of 2.54 (95% CI, 1.55-4.17, P<0.001). |
2 |
| 41. Ravichandran S, Nath N, Jones DC, et al. The utility of initial staging PET-CT as a baseline scan for surveillance imaging in stage II and III melanoma. Surgical Oncology. 35:533-539, 2020 Dec. |
Review/Other-Dx |
258 patients with completely resected melanoma who had a PET-CT within 3 months after diagnosis |
To evaluate the utility of whole-body PET-CT for the initial staging and subsequent surveillance imaging of patients with completely resected stage II and stage III melanoma. |
Of 258 total patients with completely resected melanoma who had a PET-CT within 3 months after their melanoma diagnosis, 113 had stage II and 145 had stage III melanoma. PET-CT detected distant metastasis in 3 (2.7%) of 113 stage II patients and 7 (4.8%) of 145 stage III patients. |
4 |
| 42. Weber P, Arnold A, Hohmann J. Comparison of 18F-FDG PET/CT and ultrasound in staging of patients with malignant melanoma. Medicine. 101(42):e31092, 2022 Oct 21. |
Observational-Dx |
308 patients |
To evaluate the sensitivity and specificity of 2-18fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (18F-FDG PET/CT) and ultrasound (US) for staging patients with malignant melanoma. |
Significant differences (P < .05) were found in the per-examination for the sensitivity of 18F-FDG PET/CT (0.80) compared to wUS (0.63) and pUS (0.61), and the specificity of 18F-FDG PET/CT (0.96) compared to wUS (0.98) and aUS (0.99). In the PLA, there were significant differences in sensitivity and specificity for 18F-FDG PET/CT (0.83, 0.91) compared to wUS (0.61, 0.98), pUS (0.60, 0.98), and aUS (0.61, 0.99). |
3 |
| 43. Blum A, Schlagenhauff B, Stroebel W, Breuninger H, Rassner G, Garbe C. Ultrasound examination of regional lymph nodes significantly improves early detection of locoregional metastases during the follow-up of patients with cutaneous melanoma: results of a prospective study of 1288 patients. Cancer. 88(11):2534-9, 2000 Jun 01. |
Observational-Dx |
1288 melanoma patients at 4435 follow-up consultations |
To assess the sensitivity and specificity of ultrasound versus clinical diagnosis in the detection of subcutaneous and regional metastases. |
In 504 ultrasound examinations performed on 235 patients, metastatic disease was diagnosed in 263 examinations following surgery (179 patients). Due to advanced disease or rejection, an additional 56 patients did not undergo surgery. In 239 of the 263 positive findings (90.9%), metastases from melanoma were histopathologically confirmed. In 8 cases (3%) a second malignancy and in 16 cases (6. 1%) benign lymphadenopathy was histopathologically diagnosed. Palpation of subcutaneous lymph nodes and lymph nodes gave false-negative results in 68 of the 238 cases of histopathologically proven metastases (28.6%). Clinical examination was least sensitive in the supraclavicular, axillary, and infraclavicular regions. The sensitivity and specificity for ultrasound examination were 89.2% and 99.7%, respectively, and 71.4% and 99.7% for clinical examination, respectively. |
3 |
| 44. Kahle B, Hoffend J, Wacker J, Hartschuh W. Preoperative ultrasonographic identification of the sentinel lymph node in patients with malignant melanoma. Cancer. 97(8):1947-54, 2003 Apr 15. |
Review/Other-Dx |
67 patients |
To determine whether the "sentinel lymph node" (SLN) also could be identified by ultrasound. |
In the inguinal region, the agreement between M1 and M2 was found to be 100% (40 of 40 SLNs) and was 72.5% in the axilla (29 of 40 SLNs). In patients with melanomas located on the leg, the location of M1 and M2 agreed in 97% of cases (36 of 37 lymph nodes in 30 patients); in patients with melanomas located on the arms, the agreement was 76% (13 of 17 lymph nodes in 14 patients) and in patients with melanomas located on the trunk, the agreement was 75% (21 of 28 lymph nodes in 23 patients). The position documented by ultrasound relative to the neighboring structures of the SLN was confirmed intraoperatively in all cases. |
4 |
| 45. Bafounta ML, Beauchet A, Chagnon S, Saiag P. Ultrasonography or palpation for detection of melanoma nodal invasion: a meta-analysis. Lancet Oncology. 5(11):673-80, 2004 Nov. |
Meta-analysis |
6642 patients
12 studies |
To assess the merit of ultrasonography and palpation in detection of nodal invasion in patients with melanoma. |
The main limitations were variations in the definition of false negatives, and verification bias. Ultrasonography had a higher discriminatory power (odds ratio 1755; 95% CI 726-4238) than did palpation (21 [4-111]; p=0.0001). Furthermore, positive-likelihood ratios were 41.9 (95% CI 29-75) for ultrasonography and 4.55 (2-18) for palpation; negative-likelihood ratios were 0.024 (0.01-0.03) and 0.22 (0.06-0.31), respectively. |
Good |
| 46. Prkacin I, Situm M, Delas Azdajic M, Puljiz Z. Ultrasound Assessment of Regional Lymph Nodes in Melanoma Staging. Acta Dermatovenerologica Croatica. 29(2):80-87, 2021 Jul. |
Review/Other-Dx |
202 patients |
To investigate the role of ultrasound assessment of regional lymph nodes in melanoma staging. |
No results stated in abstract. |
4 |
| 47. Rossi CR, Mocellin S, Scagnet B, et al. The role of preoperative ultrasound scan in detecting lymph node metastasis before sentinel node biopsy in melanoma patients. Journal of Surgical Oncology. 83(2):80-4, 2003 Jun. |
Observational-Dx |
125 patients |
To evaluate the efficacy of preoperative ultrasound (US) scanning in identifying lymph node metastasis before sentinel node biopsy (SNB), we conducted a prospective study on 125 patients with primary cutaneous melanoma (CM). |
Combined with fine-needle aspirate (FNA) of suspect LN, US scan allowed the correct preoperative detection of 12 out of 31 histologically positive lymphatic basins, specificity and sensitivity being 100 and 39%, respectively. The false negative rate (61%) was mainly linked to tumor deposits less than 2 mm in diameter, which can be considered the current spatial resolution limit of this technique. |
3 |
| 48. Thompson JF, Haydu LE, Uren RF, et al. Preoperative Ultrasound Assessment of Regional Lymph Nodes in Melanoma Patients Does not Provide Reliable Nodal Staging: Results From a Large Multicenter Trial. Annals of Surgery. 273(4):814-820, 2021 04 01. |
Review/Other-Tx |
2859 |
To assess whether preoperative ultrasound (US) assessment of regional lymph nodes in patients who present with primary cutaneous melanoma provides accurate staging. |
SNs were identified and removed from 2859 patients who had preoperative US evaluation. Among those patients, 548 had SN metastases. US was positive (abnormal) in 87 patients (3.0%). Among SN-positive patients, 39 (7.1%) had an abnormal US. When analyzed by lymph node basin, 3302 basins were evaluated, and 38 were true positive (1.2%). By basin, the sensitivity of US was 6.6% (95% confidence interval: 4.6–8.7) and the specificity 98.0% (95% CI: 97.5–98.5). Median cross-sectional area of all SN metastases was 0.13 mm2; in US true-positive nodes, it was 6.8 mm2. US sensitivity increased with increasing Breslow thickness of the primary melanoma (0% for =1 mm thickness, 11.9% for >4 mm thickness). US sensitivity was not significantly greater with higher trial center volume or with pre-US lymphoscintigraphy. |
4 |
| 49. Hinz T, Voth H, Ahmadzadehfar H, et al. Role of high-resolution ultrasound and PET/CT imaging for preoperative characterization of sentinel lymph nodes in cutaneous melanoma. Ultrasound in Medicine & Biology. 39(1):30-6, 2013 Jan. |
Review/Other-Dx |
20 |
The purpose of our study was the comparison of high-resolution ultrasound(HRUS) and positron emission tomography combined with computerised tomography (PET/CT) in the preoperative characterization and identification of subclinical nodal metastases focusing on sentinel lymph nodes (SLN) in melanoma patients. |
A total of 59 SLNs had been removed in those 20 patients followed by histopathologic examination. HRUS correctly identified two of 17 positive SLNs whereas PET/CT imaging identified none. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of HRUS were 11.8 % (95 % confidence interval [CI] = 3.3-34.3), 100 % (95 % CI = 91.6-100.0), 100.0 % (95 % CI = 34.2-100.0), and 73.7 % (95 % CI = 61.0-83.3), respectively. On the basis of this limited study cohort, HRUS had a better value than PET/CT in preoperative identification of positive SLNs, suggesting a possible diagnostic superiority of HRUS in general characterization of peripheral nodal disease in CM. |
4 |
| 50. Stoffels I, Dissemond J, Poeppel T, et al. Advantages of preoperative ultrasound in conjunction with lymphoscintigraphy in detecting malignant melanoma metastases in sentinel lymph nodes: a retrospective analysis in 221 patients with malignant melanoma AJCC Stages I and II. Journal of the European Academy of Dermatology & Venereology. 26(1):79-85, 2012 Jan. |
Review/Other-Dx |
221 |
The present retrospective study seeks to clarify the reliability of preoperative ultrasonography (US) in directcomparison to the result of SLNE and seeks to identify potential advantages of preoperative ultrasound if performed inconjunction with lymphoscintigraphy in detecting malignant melanoma metastases in sentinel lymph node (SLN). |
Of the 221 patients, 77.4% (n = 171) had a negative SLN. In 50 patients (22.6%), the histopathologicalinvestigation of 71 excised lymph nodes resulted in a positive SLN. The US examination demonstrated a sensitivityof 13.6%, a specificity of 96.9%, a positive predictive value of 97.2% and a negative predictive value of 12.6%.SLNE alone shows a sensitivity of 94%, a specificity of 98.6%, a positive predictive value of 100% and a negativepredictive value of 98.3%. Preoperative US in conjunction with dynamic lymphoscintigraphy, followed by SLNE,demonstrated a detecting ratio of 100% (n = 28) for micrometastases and 98.6% (n = 42 / 43) for macrometastases. |
4 |
| 51. Voit C, Van Akkooi AC, Schafer-Hesterberg G, et al. Ultrasound morphology criteria predict metastatic disease of the sentinel nodes in patients with melanoma. Journal of Clinical Oncology. 28(5):847-52, 2010 Feb 10. |
Observational-Dx |
650 patients |
Ultrasound (US)-guided fine needle aspiration cytology (FNAC) can accurately identify the sentinel node (SN). |
Median Breslow was 1.8 mm. The sensitivity and positive predictive value of the most important factors were: peripheral perfusion (PP) present (77% and 52%, respectively), loss of central echoes (LCE; 60% and 65% respectively), and balloon shape (BS; 30% and 96% respectively). Together these factors have a sensitivity of 82% and PPV of 52% (P < .001). PP identified more patients with lower volume disease. PP and combined BS and LCE were independent prognostic factors for survival (hazard ratio, 2.19; P < .015; and hazard ratio, 5.50; P < .001, respectively). |
3 |
| 52. Ghanem N, Altehoefer C, Hogerle S, et al. Detectability of liver metastases in malignant melanoma: prospective comparison of magnetic resonance imaging and positron emission tomography. European Journal of Radiology. 54(2):264-70, 2005 May. |
Observational-Dx |
35 patients |
To evaluate the diagnostic accuracy of magnetic resonance imaging (MRI) and positron emission tomography (PET) for detection of liver metastases in malignant melanoma. |
MRI and PET were concordantly negative for presence and number of liver metastases in 28 patients and positive in four patients. PET and MRI were false positive in one patient each. In one patient MRI showed a single metastases not seen by PET and in one patient MRI demonstrated more metastases at the first examination. In follow-up investigations MRI revealed more metastases than PET in both patients. The sensitivities for lesion detection were 47% (16/34) for PET and 100% for MRI. Lesion detectability by PET was related to lesion size (P < 0.0001) but not to melanin content. |
2 |
| 53. Deike-Hofmann K, Thunemann D, Breckwoldt MO, et al. Sensitivity of different MRI sequences in the early detection of melanoma brain metastases. PLoS ONE [Electronic Resource]. 13(3):e0193946, 2018. |
Observational-Dx |
1,210 patients |
To investigate the sensitivity of six clinical magnetic resonance imaging (MRI) sequences in the early detection of melanoma brain metastases (MBM). |
Of 1210 patients, 217 with MBM were included in the analysis and up to 5 lesions per patient were evaluated. A total of 720 metastases were assessed and all six sequences were available for 425 MBM. Sensitivity (conspicuity =2) was 99.7% for ceT1w, 77.0% for FLAIR, 64.7% for SWI, 61.0% for T2w, 56.7% for T1w, and 48.4% for DWI. Thirty-one (7.3%) of 425 lesions were only detectable by ceT1w but no other sequence. |
3 |
| 54. Gold JS, Jaques DP, Busam KJ, Brady MS, Coit DG. Yield and predictors of radiologic studies for identifying distant metastases in melanoma patients with a positive sentinel lymph node biopsy. Annals of Surgical Oncology. 14(7):2133-40, 2007 Jul. |
Review/Other-Dx |
181 patients with positive SLNB |
To evaluate the yield of radiological studies employed to detect distant disease in patients with melanoma found to have a positive sentinel lymph node (SLN). |
Over an 8-year period, 181 patients had a positive SLNB. At least one study (computed tomography or magnetic resonance imaging of the brain; chest x-ray; computed tomography of the thorax, abdomen, or pelvis; positron-emission tomography scan; or bone scan) was obtained around the time of SLNB in 178 patients (98%). Studies were obtained after SLNB in 107 patients (59%). Studies ordered after SLNB resulted in indeterminate findings in 51 patients (48% of those studied). Among patients tested after SLNB, four were found to have metastatic disease (positive rate 3.7%). All of these patients had both a thick melanoma and macrometastasis within the SLN. The number of patients with indeterminate findings would be decreased and the yield of the work-up increased by 4 fold, by restricting the work-up to those with thick melanoma and macrometastasis. |
4 |
| 55. Tsao H, Feldman M, Fullerton JE, Sober AJ, Rosenthal D, Goggins W. Early detection of asymptomatic pulmonary melanoma metastases by routine chest radiographs is not associated with improved survival. Archives of Dermatology. 140(1):67-70, 2004 Jan. |
Observational-Dx |
994 |
To determine if earlier detection of pulmonary metastasis by routine chest radiography (CR) is associated with a prolonged survival. A computer-assisted search of all CR reports on patients with melanoma between 1990 and 1994 at the Massachusetts General Hospital, Boston. Positive or suspicious findings for pulmonary metastasis were further pursued through review of medical records and tumor registry files. |
Of the 1938 chest radiographs from 994 patients with melanoma obtainedover the 5-year period (1990-1994), 1783 (92.0%) were normal and 155 (8.6%)were positive or questionable (Figure 1).On further analysis, of these 155 chest radiographs, 63 were eventually foundto be false positive (false-positive rate: 63/[1783 + 63] or 3.4%). Of theremaining 92 suspicious chest radiographs, 75 represented true pulmonary metastaseson follow-up and additional investigations. Each of the 75 chest radiographswere from separate individuals; 34 individuals had CR findings suggestiveof pulmonary metastasis in the context of known distant disease (K-IV), while41 (4% of all patients) demonstrated their stage IV disease through CR findings(C-IV). There were 7 chest radiographs that were later found to representcancers in the lung other than melanoma (1 squamous cell carcinoma of thelung, 5 adenocarcinomas of the lung, and 1 metastatic breast cancer), and6 suspicious chest radiographs were from persons with ocular or mucosal melanomaand were excluded from the study. Four chest radiographs were from patientswho had no further contact with MGH and thus whose outcome could not be determined. |
3 |
| 56. Madu MF, Timmerman P, Wouters MWJM, van der Hiel B, van der Hage JA, van Akkooi ACJ. PET/CT surveillance detects asymptomatic recurrences in stage IIIB and IIIC melanoma patients: a prospective cohort study. Melanoma Research. 27(3):251-257, 2017 06. |
Review/Other-Dx |
51 patients with stage IIIB and IIIC melanoma |
To evaluate a PET/computed tomography (CT) surveillance schedule for resected stage IIIB and IIIC melanoma. |
Fifty-one patients were followed up, 27 patients developed a recurrence before surveillance imaging, five were detected by an elevated S100B, and one patient was not scanned according to protocol. Eighteen patients were included. Thirty-two scans were acquired. Eleven relapses were suspected on PET/CT. Ten scans were true positive, one case was false positive, and one case was false negative. |
4 |
| 57. O'Regan K, Breen M, Ramaiya N, et al. Metastatic mucosal melanoma: imaging patterns of metastasis and recurrence. Cancer Imaging. 13(4):626-32, 2013 Dec 30. |
Review/Other-Dx |
19 patients (5 male, 14 female) |
To present our clinical experience with multimodality imaging of this rare tumor at a tertiary referral oncology center. |
At presentation, disease was confined to the primary site (58%, n = 11) or to the regional lymph nodes (32%, n = 6) in most patients. The most common site of metastasis was the lungs (89%, n = 16), followed by the liver (67%, n = 12) and peritoneum (44%, n = 8). Sinonasal melanoma preferentially spread to the liver (100%, n = 4), vaginal melanoma to the lungs (100%, n = 7) and anal melanoma to the inguinal lymph nodes (100%, n = 4). |
4 |
| 58. Helvind NM, Aros Mardones CA, Holmich LR, et al. Routine PET-CT scans provide early and accurate recurrence detection in asymptomatic stage IIB-III melanoma patients. European Journal of Surgical Oncology. 47(12):3020-3027, 2021 Dec. |
Observational-Dx |
138 patients |
To examine the sensitivity, specificity, negative and positive predictive values, numbers-needed-to-scan and clinical impact of routine PET-CT in the surveillance of asymptomatic stage IIB-III melanoma patients. |
In 138 patients, 243 routine PET-CTs were performed within a median follow-up time of 17.7 months. Routine PET-CT detected recurrence at least once in 25 patients (18.1%), including distant recurrence in 19 patients (13.8%). Stage IIB patients had the lowest recurrence rate (11.1%). Numbers-needed-to-scan to detect one distant recurrence was 12.8 patients and median time-to-recurrence was 6.8 months. Sensitivity was 100%, specificity was 94.7% and negative and positive predictive values were 100% and 74.4%, respectively. False positive findings prompted 22 additional investigations (of which ten invasive) in 17 patients (12.3%). |
3 |
| 59. McIvor J, Siew T, Campbell A, McCarthy M. FDG PET in early stage cutaneous malignant melanoma. Journal of Medical Imaging & Radiation Oncology. 58(2):149-54; quiz 266, 2014 Apr. |
Review/Other-Dx |
322 |
Fluorodeoxyglucose positron emission tomography (FDG PET) isnot recommended in early stage melanoma; however, a significant number ofcases are referred to our institution for FDG PET. We refer to early stagedisease as American Joint Committee on Cancer (AJCC) stage I and II, whichincludes all cases without metastases. A retrospective review was undertakento determine the clinical utility of FDG PET in this patient group. |
Three hundred twenty-two patients were included in the study, ofwhich 74 had initial positive FDG PET scans (23%). Adequate follow-up wasavailable in 51 patients with the PET result confirmed as true positive in 37(positive predictive value 73%). One hundred eight of 248 patients initiallynegative had follow-up scans during the follow-up period, of which 48 becamepositive. The 73% of recurrences were over 12 months post-diagnosis. Nocorrelation with Breslow thickness was demonstrated. |
4 |
| 60. Williams A, Hamilton O, Likar C, Thomay A, Garland-Kledzik M. "The Benefit Of Positron Emission Tomography/Computed Tomography In Stage I And Stage II Melanomas With High-Risk Decisiondx-Melanoma Scores". American Surgeon. 88(7):1446-1451, 2022 Jul. |
Review/Other-Dx |
297 |
Early detection of melanoma is instrumental as the 5-year survival decreases from 93.3% to <50% whenmetastases are present.1-3 Distinguishing which patients require closer follow-up can be difficult for melanoma patients.Developments by Castle Biosciences’ (Friendswood, TX) DecisionDx-Melanoma (DDx-M) use 31 melanoma associatedgenes to stratify melanomas into 4 classes with 1A having lowest risk of morbidity and mortality and 2B the highest.5 Weassessed the benefit of providing additional 18FDG-PET-CT and brain MRI to genetically high-risk patients who may haveotherwise been overlooked. |
Methods: 297 patients at our institution had biopsies sent for DDx-M between 2014 and 2021. Patients found to haveClass 2 melanomas received additional screening with yearly 18FDG-PET-CT scans and brain MRIs. Patients with Class 2DDx-M scores and negative SLNB were included in the study. 66 met inclusion criteria and received imaging.Results: Within 3 years of follow-up, 8/66 (12.1%) patients had metastases detected by 18FDG-PET-CT scans. Nopatients with stage IA or IB went on to develop metastases. |
4 |
| 61. Ribero S, Podlipnik S, Osella-Abate S, et al. Ultrasound-based follow-up does not increase survival in early-stage melanoma patients: A comparative cohort study. European Journal of Cancer. 85:59-66, 2017 11. |
Observational-Dx |
1149 |
Different protocols have been used to follow up melanoma patients in stage I-II. However, there is no consensus on the complementary tests that should be requested or the appropriate intervals between visits. Our aim is to compare an ultrasound-based follow-up with a clinical follow-up. |
A total of 1149 patients in the American Joint Committee on Cancer stage IB and IIA were included in this study, of which 554 subjects (48%) were enrolled for a C-FU, and 595 patients (52%) received a protocolised US-FU. The median age was 53.8 years (interquartile range [IQR] 41.5-65.2) with a median follow-up time of 4.14 years (IQR 1.2-7.6). During follow-up, 69 patients (12.5%) in C-FU and 72 patients (12.1%) in US-FU developed disease progression. Median time to relapse for the first metastatic site was 2.11 years (IQR 1.14-4.04) for skin metastases, 1.32 (IQR 0.57-3.29) for lymph node metastases and 2.84 (IQR 1.32-4.60) for distant metastases. The pattern of progression and the total proportion of metastases were not significantly different (P = .44) in the two centres. No difference in DFI, DMFS, NMFS and MSS was found between the two cohorts. |
3 |
| 62. Brooks WC, Votanopoulos KI, Russell GB, Shen P, Levine EA. Evaluation of Chest Radiographs and Laboratory Testing during Melanoma Staging Procedures. American Surgeon. 85(5):505-510, 2019 May 01. |
Review/Other-Dx |
309 |
This study evaluates the utility of routine CXRs and laboratory testing during the staging of clinical stage 1 and 2 melanoma patients. |
A total of 315 patients underwent a preoperative CXR, whereas 309 received some laboratory testing. After sentinel node biopsies, 168 patients had pathologic stage 1 disease, 103 stage 2, and 44 stage 3. None of the CXRs (0%) correctly identified metastatic melanoma. Suspicious locations on CXRs and laboratory testing did not lead to metastatic findings in any patient within a year. Metastatic melanoma was not found in any patient by screening with CXRs or laboratory testing during preoperative workup. We recommend not conducting CXRs or laboratory testing during workup for surgical melanoma patients because of charges and anxiety these tests can cause. CXRs, blood tests, and metabolic panels have historically been ordered for early melanoma patients, although debate remains on their efficacy. Surgical patient records were retrospectively reviewed for these tests and no benefit was found. |
4 |
| 63. Kurtz J, Beasley GM, Agnese D, et al. Surveillance strategies in the follow-up of melanoma patients: too much or not enough?. Journal of Surgical Research. 214:32-37, 2017 06 15. |
Review/Other-Dx |
369 |
We retrospectively reviewed 369 patients with stage II and III melanoma treated at Ohio State University from 2009-2015, who underwent surgery as primary therapy. Two hundred forty-seven patients who were followed for a minimum of 6 mo after surgical resection to achieve no evidence of disease status (NED) were included in this analysis. One hundred twenty-two were lost to follow-up after surgery and were excluded. |
The rate of recurrence for stage IIA/IIB patients was 11% (14/125). Eleven of the 14 (79%) recurrences were detected by clinical symptoms or physical examination. Thirty-nine percent (49/125) of stage IIA or IIB patients were followed by clinical examination only, whereas 61% (76/125) were followed with at least two serial chest x-rays. The median time to first chest x-ray after NED status was 4.7 mo (n = 76), median time to second chest x-ray after NED status was 12.7 mo (n = 76), and 66% (50/76) continued to have additional serial chest x-rays. At median follow-up of 35 mo for the 125 patients with stage IIA/IIB, there was no difference in survival between those followed clinically (95% [95% CI: 0.88-0.99]) versus those followed with at least two serial x-rays (96% [95% CI: 0.89-0.98]). For stage IIC/IIIA-C patients, recurrence was detected in 23% (28/122) at median follow-up 31.2 mo. Fifty percent of recurrences were detected by imaging in asymptomatic patients, whereas 50% (14/28) had recurrence detected on imaging associated clinical findings. Eighty-seven percent (106/122) of stage IIC/IIIA-C patients were followed with at least two serial whole body positron emission tomography/computed tomography (CT) scans or whole body CT scans plus brain magnetic resonance imaging; median time between NED status and second scan was 10.3 mo. Of stage IIC/IIIA-C patients with recurrence, 57% (16/28) went on to surgical resection of the recurrence, whereas 11 (39%) patients received B-RAF inhibitor therapy, immune blockade therapy, or combination therapy. |
4 |
| 64. Orfaniotis G, Mennie JC, Fairbairn N, Butterworth M. Findings of computed tomography in stage IIB and IIC melanoma: a six-year retrospective study in the South-East of Scotland. Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS. 65(9):1216-9, 2012 Sep. |
Observational-Dx |
172 patients |
To investigate regional computed tomography (CT) findings in those patients diagnosed with (American Joint Cancer Committee) IIB and IIC disease, and establish whether our findings affirmed new UK guidelines. |
A total of 269 scans were performed on 130/172 patients. One hundred and four initial staging CT scans were performed on 75 patients, and detected one (1.3%) occult melanoma metastasis. At follow-up, 165 scans were performed in 82 patients and detected 56 metastasis in 32(39%) patients leading to a change in management in 29(35%). Two of these 32 patients had occult melanoma metastasis. Symptomatic patients had statistically significant more metastatic disease diagnosed at follow-up CT scanning than asymptomatic patients p < 0.0001. Head CT detected 15/56 (27%) of all metastasis. |
3 |
| 65. Eggen AC, Wind TT, Bosma I, et al. Value of screening and follow-up brain MRI scans in patients with metastatic melanoma. Cancer Medicine. 10(23):8395-8404, 2021 12. |
Review/Other-Dx |
116 patients |
To determine the impact of screening MRI scans in patients with metastatic melanoma and follow-up MRI scans in patients with melanoma brain metastases. |
In total, 116 patients had no brain metastases at the time of the metastatic melanoma diagnosis. Twenty-eight of these patients (24%) were subsequently diagnosed with brain metastases. Screening MRI scans detected the brain metastases in 11/28 patients (39%), of which 8 were asymptomatic at diagnosis. In the 96 patients with melanoma brain metastases, treatment strategy changed after 75/168 follow-up MRI scans (45%). In patients treated with immune checkpoint inhibitors, the number of treatment changes after follow-up MRI scans was lower when patients had been treated longer. |
4 |
| 66. Podlipnik S, Carrera C, Sanchez M, et al. Performance of diagnostic tests in an intensive follow-up protocol for patients with American Joint Committee on Cancer (AJCC) stage IIB, IIC, and III localized primary melanoma: A prospective cohort study. Journal of the American Academy of Dermatology. 75(3):516-524, 2016 Sep. |
Observational-Dx |
290 patients |
To analyze the performance of the follow-up components and identify procedures that detect melanoma metastasis earlier. |
A total of 2382 clinical examinations and 3069 imaging tests were performed. The patients completed 899.8 person-years of follow-up, with a median of 2.5 years. In all, 115 recurrences in 290 patients were recorded, of which computed tomography detected 48.3%; brain magnetic resonance imaging, 7.6%; laboratory test, 2.5%; physician, 23.7%; and patient, 17.8%. |
4 |
| 67. Lewin J, Sayers L, Kee D, et al. Surveillance imaging with FDG-PET/CT in the post-operative follow-up of stage 3 melanoma. Annals of Oncology. 29(7):1569-1574, 2018 07 01. |
Observational-Dx |
170 patients |
To evaluate stage 3 melanoma patients who underwent prospectively applied and sub-stage-specific schedules of positron emission tomography (PET) surveillance. |
One hundred and seventy patients (stage 3A: 34; 3B: 93; 3C: 43) underwent radiological surveillance. Relapses were identified in 65 (38%) patients, of which 45 (69%) were asymptomatic. False-positive imaging findings occurred in 7%, and 6% had treatable second (non-melanoma) malignancies. Positive predictive values (PPV) of individual scans were 56%-83%. Negative scans had predictive values of 89%-96% for true non-recurrence [negative predictive values (NPV)] until the next scan. A negative PET at 18 months had NPVs of 80%-84% for true non-recurrence at any time in the 47-month (median) follow-up period. Sensitivity and specificity of the overall approach of sub-stage-specific PET surveillance were 70% and 87%, respectively. Of relapsed patients, 33 (52%) underwent potentially curative resection and 10 (16%) remained disease-free after 24 months (median). |
3 |
| 68. Helvind NM, Weitemeyer MB, Chakera AH, et al. Earlier Recurrence Detection Using Routine FDG PET-CT Scans in Surveillance of Stage IIB to IIID Melanoma: A National Cohort Study of 1480 Patients. Annals of Surgical Oncology. 30(4):2377-2388, 2023 Apr. |
Review/Other-Dx |
1480 patients |
To determine the impact of surveillance with routine FDG PET-CT on hazard, cumulative incidence, and absolute risk of overall, locoregional, and distant recurrence detection in patients with stage IIB to IIID cutaneous melanoma. |
The study included 1480 patients with stage IIB to IIID cutaneous melanoma. Cumulative incidences of overall and distant recurrence were higher in cohort 2, with a peak difference at three years (32.3 % vs 27.5 % and 25.8 % vs. 18.5 %, respectively). The hazard of recurrence was higher in cohort 2 during the first two years, with hazard rates for overall and distant recurrence of 1.16 (95 % confidence interval [CI], 0.93-1.44) and 1.51 (95 % CI, 1.16-1.96), respectively. The patterns persisted in absolute risk estimates. |
4 |
| 69. Jaeger ZJ, Williams GA, Chen L, Mhlanga JC, Cornelius LA, Fields RC. 18 F-FDG positron emission tomography-computed tomography has a low positive predictive value for detecting occult recurrence in asymptomatic patients with high-risk Stages IIB, IIC, and IIIA melanoma. Journal of Surgical Oncology. 125(3):525-534, 2022 Mar. |
Review/Other-Dx |
158 patients |
To determine the utility of 18 F-fluorodeoxyglucose (18 F-FDG) positron emission tomography/computed tomography (PET/CT) for detecting asymptomatic recurrence of melanoma after primary surgical resection. |
We calculated a positive predictive value (PPV) of 32% (95% confidence interval: 11%-53%) for 154 routine PET/CTs, including six true positives and 13 false positives (FPs). PPV was 33% for Stage IIB, 50% for Stage IIC, and 14% for Stage IIIA. FPs were mostly benign or inflammatory foci (75%), and some other malignancies were found (21%). |
4 |
| 70. Abbott RA, Acland KM, Harries M, O'Doherty M. The role of positron emission tomography with computed tomography in the follow-up of asymptomatic cutaneous malignant melanoma patients with a high risk of disease recurrence. Melanoma Research. 21(5):446-9, 2011 Oct. |
Review/Other-Dx |
3 |
The aim of this study was to evaluate the role of [F] fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) as a surveillance tool in asymptomatic patients with primary cutaneous melanoma with the American Joint Committee on Cancer stage 3 disease. Thirty-four patients with primary cutaneous malignant melanoma with American Joint Committee on Cancer stage 3 disease, who underwent at least one annual surveillance PET/CT scan, were retrospectively identified from our PET Centre Database in May 2008 and their characteristics, PET/CT results and disease course were reviewed. In 20 patients with microscopic stage 3 disease at diagnosis, annual surveillance PET/CT detected two of three recurrences and detected one incidental breast carcinoma. In 14 patients with macroscopic stage 3 disease at, or subsequent to, their initial diagnosis, annual PET/CT detected four of four recurrences, detected metastases in one patient who remains asymptomatic and detected one incidental thyroid carcinoma. PET/CT seems to be a useful surveillance tool in patients with macroscopic stage 3 disease, although the numbers in this study are small. However, the role of PET/CT in patients initially presenting with microscopic stage 3 disease requires further confirmation. |
Twenty patients underwent an initial surveillance PET/CT. Of these 20 patients, two have developed reoccurences that were first detected on their surveillance PET/CT. One of these two patients had an intransit metastasis identified on the right tibia, which was subsequently excised with curative intent. The other patient had a lung metastasis identified on PET/CT and was referred to the cardiothoracic team for resection but was not thought to be a good candidate for surgery. One patient developed a local recurrence within 1 month, which was not detected on PET.CT; however, it was detected on clinical review and excised with curative intent. Another patient developed breast carcinoma that was detected intially on PET/CT. Of the original 20 patients, so far eight have subsequently undergone a second surveillence PET/CT and two patients have undergone a third surveillance PET/CT. No evidence of malignant disease was identified and no patients have subsequently developed a recurrence having been followed up clinically for at least 6 months following each surveillence PET/CT. |
4 |
| 71. Koskivuo I, Kemppainen J, Giordano S, et al. Whole body PET/CT in the follow-up of asymptomatic patients with stage IIB-IIIB cutaneous melanoma. Acta Oncologica. 55(11):1355-1359, 2016 Nov. |
Observational-Dx |
110 |
Whole body positron emission tomography (PET)/computed tomography (CT) is a sensitive imaging technique in patients with metastatic melanoma, but its role in the follow-up of asymptomatic high-risk patients is unclear. The aim was to study the role of PET/CT as a routine surveillance imaging tool in asymptomatic high-risk patients at the early stage of follow-up combined with a sufficient follow-up over several years |
Recurrent melanoma was detected in 45 patients (41%) and 36 (33%) died of melanoma. In 11 asymptomatic patients (10%) occult disease was detected with a single PET/CT. In seven of these patients (64%), positive PET/CT finding had major influence in treatment decisions. Four patients underwent surgical metastasectomy and two of them remained disease-free. In 34 patients (31%) PET/CT revealed no disease, but recurrence was detected at a median time of 19 months after negative PET/CT scan. In 50 patients (45%) PET/CT finding was true negative. In 15 patients (14%) scan was false positive leading to additional management or repetitive imagings. |
3 |
| 72. Leon-Ferre RA, Kottschade LA, Block MS, et al. Association between the use of surveillance PET/CT and the detection of potentially salvageable occult recurrences among patients with resected high-risk melanoma. Melanoma Research. 27(4):335-341, 2017 08. |
Observational-Dx |
299 patients with completely resected stage III-IV melanoma who had at least one surveillance PET/CT within a year from surgery |
To evaluate whether surveillance PET/CT in patients with resected stage III-IV melanoma led to detection of clinically occult recurrences amenable to curative-intent salvage treatment. |
Overall, 162 (52%) patients developed recurrence [locoregional: 77 (48%), distant: 85 (52%)]. The first recurrence was clinically occult in 98 (60%) and clinically evident in 64 (40%). Clinically evident recurrences were more often superficial (skin, subcutaneous, or nodal) or in the brain, whereas clinically occult recurrences more often visceral. Overall, 90% of all recurrences were detected by 2.8 years. In all, 70% of patients with recurrence underwent curative-intent salvage treatment (locoregional: 94%, distant: 48%), with similar rates for clinically occult versus clinically evident recurrences (66 vs. 75%, P=0.240). Overall survival was superior among those who underwent curative-intent salvage treatment [5.9 vs. 1.2 years; hazard ratio=4.27, 95% confidence interval (CI)=2.68-6.80; P<0.001], despite 79% developing recurrence again. PET/CT had high sensitivity (88%, 95% CI=79.94-93.31%), specificity (90%, 95% CI=88.56-91.56%), and negative predictive value (99%, 95% CI=98.46-99.52%). However, the positive predictive value was only 37% (95% CI=31.32-43.68%). |
3 |
| 73. Beasley GM, Parsons C, Broadwater G, et al. A multicenter prospective evaluation of the clinical utility of F-18 FDG-PET/CT in patients with AJCC stage IIIB or IIIC extremity melanoma. Annals of Surgery. 256(2):350-6, 2012 Aug. |
Observational-Dx |
97 patients |
To evaluate response to treatment or for surveillance after treatment is currently not well defined. |
Complete response (CR) after ILI occurred in 33% (32/97) of patients. FDG-PET/CT accurately identified 59% of patients who were CRs (19/32), whereas 41% (13/32) had residual metabolic activity in the extremity that was histologically negative for melanoma. The 3-year disease-free rate was 62.2% (95% CI: 40.1%-96.4%) for those patients who were CRs by both clinical/pathologic examination and FDG-PET/CT (n = 19) compared to only 29.4% (95% CI: 9.9%-87.2%) of those CRs who still had residual FDG-PET/CT activity (n = 13). FDG-PET/CT was utilized for surveillance of disease recurrence outside the regional field of treatment. Fifty-two percent (51/97) of patients developed disease outside the extremity at a median time of 212 days from pre-ILI FDG-PET/CT. In 47% (29/62) of these cases, the recurrence was resected. |
4 |
| 74. Machet L, Nemeth-Normand F, Giraudeau B, et al. Is ultrasound lymph node examination superior to clinical examination in melanoma follow-up? A monocentre cohort study of 373 patients. British Journal of Dermatology. 152(1):66-70, 2005 Jan. |
Observational-Dx |
373 patients |
To study the value of adding ultrasound lymph node examination (7.5 MHz) to the routine clinical examination recommended by French guidelines in melanoma follow-up. |
Ultrasound follow-up was performed for 373 patients (213 females and 160 males). Mean age at diagnosis of melanoma was 59 years (range 14-90, SD 15). In total, 1909 ultrasound examinations combined with clinical examination were analysed. Node biopsy was performed in 65 patients and demonstrated melanoma metastases in 54. Sensitivity of clinical examination and ultrasound examination was 71.4%[95% confidence interval (CI) 55.4-84.3] and 92.9 (95% CI 80.5-98.5), respectively, P = 0.02. Specificity of clinical examination and ultrasound examination was 99.6% (95% CI 99.2-99.8) and 97.8% (95% CI 97.0-98.4), respectively. Despite this apparent superiority of ultrasound examination over palpation, only 7.2% of the patients really benefited from ultrasound examination (earlier lymph node metastasis detection or avoidance of unnecessary surgery), while 5.9% had some deleterious effect from ultrasound examination (unnecessary stress caused by repetition of ultrasound examination for benign lymph nodes, useless removal of benign lymph node). |
2 |
| 75. Gjorup CA, Woodford R, Li I, et al. Role of Concurrent Ultrasound Surveillance of Sentinel Node-Positive Node Fields in Melanoma Patients Having Routine Cross-Sectional Imaging. Annals of Surgical Oncology. 31(3):1857-1864, 2024 Mar. |
Observational-Dx |
225 patients |
The purpose of our study was to describe the modality of detection of nodal recurrence in sentinel node-positive (SN+ve) node fields. |
A total of 225 SN+ve patients with a median follow-up of 23 months were included. Of these, 119 (53%) received adjuvant systemic therapy. Eighty (36%) developed a recurrence at any site; 24 (11%) recurred first in the SN+ve field, of which 12 (5%) were confirmed node field recurrence only at 2 months follow-up. The nodal recurrences were first detected by ultrasound in seven (3%), CT in seven (3%), and PET/CT in seven (3%) patients. All nodal recurrences evident on US were also evident on PET/CT and vice versa. |
3 |
| 76. Winkler N, Rezvani M, Heilbrun M, Shaaban A. Utility of dual phase liver CT for metastatic melanoma staging and surveillance. European Journal of Radiology. 82(12):2189-93, 2013 Dec. |
Review/Other-Dx |
188 patients |
To evaluate the clinical utility of dual phase computed tomography (CT) for assessment of hepatic metastases in patients with metastatic melanoma. |
In no case was hepatic metastatic disease only apparent on arterial phase imaging. Arterially enhancing hepatic lesions only visible on the arterial phase or much more conspicuous on the arterial phase were present in 10 studies (10%), all of which were benign. Liver metastases were rated as being more accurately assessed on the portal venous phase in up to 100%. In a per scan analysis dual phase and venous phase imaging had similar sensitivities of 96% (95%, CI: 86-100) and 98% (95%, CI: 89-100), respectively. |
4 |
| 77. Morton RL, Craig JC, Thompson JF. The role of surveillance chest X-rays in the follow-up of high-risk melanoma patients. Annals of Surgical Oncology. 16(3):571-7, 2009 Mar. |
Observational-Dx |
108 patients |
To evaluate the accuracy of detecting asymptomatic pulmonary metastases by surveillance CXRs in melanoma patients with a positive sentinel node biopsy. |
21% (23/108) developed pulmonary metastases, which were detected in 48% (11/23) by surveillance CXR (sensitivity, 48%; 95% CI, .27-.68), leading to resection in 13% (3/23). CXRs were abnormal in 19 additional patients but not due to recurrence (specificity, 78%; 95% CI, .77-.79). Additional metastatic disease was apparent in 18% of CXR-detected vs 76% of non-CXR-detected patients (P<.05), but median time to diagnosis of pulmonary metastases was 24 months (95% CI, 12-41) vs 16 months (95% CI, 10-30, P=.30 log rank) and median survival of 42 months (95% CI, 24-84) vs 36 months (95% CI, 18-46, P=.53 log rank) were not significantly different. The 6 to 12 monthly surveillance CXRs detected only half of pulmonary metastases, infrequently identified patients for potentially curative surgery, and did not lead to earlier detection of pulmonary metastases. Further, they may cause unnecessary patient anxiety, given the high rate of false-positive findings. |
3 |
| 78. DeRose ER, Pleet A, Wang W, et al. Utility of 3-year torso computed tomography and head imaging in asymptomatic patients with high-risk melanoma. Melanoma Research. 21(4):364-9, 2011 Aug. |
Observational-Dx |
210 patients |
To determine the utility and cost effectiveness of radiologic restaging of patients with stage IIB-IIIC melanoma at the 3-year follow-up time point. |
Fifty-five percent of patients followed at BIDMC recurred; 88% before 3 years (median time to recurrence 12 months, 95% CI: 10–16 months). The majority (69%) recurred with disease symptoms. Twenty five head CT scans, 27 head MRIs, and 52 torso CTs were performed. One false positive head CT and 5 abnormal torso CT scans (3 false positive, 2 true positive) were identified. The total cost per diagnosis was $312,990. |
3 |
| 79. Yan MK, Adler NR, Wolfe R, et al. The role of surveillance imaging for resected high-risk melanoma. Asia-Pacific Journal of Clinical Oncology. 19(4):566-573, 2023 Aug. |
Review/Other-Dx |
199 patients |
To examine the utility of imaging in patients with a high-risk primary melanoma undergoing a protocolized imaging schedule. |
Over a median follow-up time of 2.7 years, 199 patients underwent surveillance imaging (T4bNX:22, IIC:33, IIIA:22, IIIB:60, IIIC:61, IIID:1), and 44% (n = 88) experienced disease recurrence. Imaging detected over half (53%) of all recurrences. In adjusted analyses, mortality risk was reduced after an imaging-detected compared to clinically-detected recurrence at any given time from the start of surveillance (hazard ratio 0.25, 95% confidence interval 0.10-0.66, p = .005). |
4 |
| 80. Dinnes J, Ferrante di Ruffano L, Takwoingi Y, et al. Ultrasound, CT, MRI, or PET-CT for staging and re-staging of adults with cutaneous melanoma. Cochrane Database of Systematic Reviews. 7:CD012806, 2019 07 01. |
Review/Other-Dx |
39 publications (5204 study participants) |
Primary Objective: To estimate accuracy separately according to the point in the clinical pathway at which imaging tests were used.To determine the diagnostic accuracy of ultrasound or PET-CT for detection of nodal metastases before sentinel lymph node biopsy in adults with confirmed cutaneous invasive melanomaTo determine the diagnostic accuracy of ultrasound, CT, MRI, or PET-CT for whole body imaging in adults with cutaneous invasive melanomaSecondary Objective: To determine the diagnostic accuracy of ultrasound, CT, MRI, or PET-CT for whole body imaging (detection of any metastasis) in mixed or not clearly described populations of adults with cutaneous invasive melanomaTo determine the diagnostic accuracy of ultrasound, CT, MRI, or PET-CT for detection of nodal metastasesTo determine the diagnostic accuracy of ultrasound, CT, MRI, or PET-CT for detection of distant metastasesTo determine the diagnostic accuracy of ultrasound, CT, MRI, or PET-CT for detection of distant metastases according to metastatic site. |
We included a total of 39 publications reporting on 5204 study participants; 34 studies reporting data per patient included 4980 study participants with 1265 cases of metastatic disease, and seven studies reporting data per lesion included 417 study participants with 1846 potentially metastatic lesions, 1061 of which were confirmed metastases. The risk of bias was low or unclear for all domains apart from participant flow. Concerns regarding applicability of the evidence were high or unclear for almost all domains. Participant selection from mixed or not clearly defined populations and poorly described application and interpretation of index tests were particularly problematic.The accuracy of imaging for detection of regional nodal metastases before sentinel lymph node biopsy (SLNB) was evaluated in 18 studies. In 11 studies (2614 participants; 542 cases), the summary sensitivity of ultrasound alone was 35.4% (95% confidence interval (CI) 17.0% to 59.4%) and specificity was 93.9% (95% CI 86.1% to 97.5%). Combining pre-SLNB ultrasound with FNAC revealed summary sensitivity of 18.0% (95% CI 3.58% to 56.5%) and specificity of 99.8% (95% CI 99.1% to 99.9%) (1164 participants; 259 cases). Four studies demonstrated lower sensitivity (10.2%, 95% CI 4.31% to 22.3%) and specificity (96.5%,95% CI 87.1% to 99.1%) for PET-CT before SLNB (170 participants, 49 cases). When these data are translated to a hypothetical cohort of 1000 people eligible for SLNB, 237 of whom have nodal metastases (median prevalence), the combination of ultrasound with FNAC potentially allows 43 people with nodal metastases to be triaged directly to adjuvant therapy rather than having SLNB first, at a cost of two people with false positive results (who are incorrectly managed). Those with a false negative ultrasound will be identified on subsequent SLNB.Limited test accuracy data were available for whole body imaging via PET-CT for primary staging or re-staging for disease recurrence, and none evaluated MRI. Twenty-four studies evaluated whole body imaging. Six of these studies explored primary staging following a confirmed diagnosis of melanoma (492 participants), three evaluated re-staging of disease following some clinical indication of recurrence (589 participants), and 15 included mixed or not clearly described population groups comprising participants at a number of different points on the clinical pathway and at varying stages of disease (1265 participants). Results for whole body imaging could not be translated to a hypothetical cohort of people due to paucity of data.Most of the studies (6/9) of primary disease or re-staging of disease considered PET-CT, two in comparison to CT alone, and three studies examined the use of ultrasound. No eligible evaluations of MRI in these groups were identified. All studies used histological reference standards combined with follow-up, and two included FNAC for some participants. Observed accuracy for detection of any metastases for PET-CT was higher for re-staging of disease (summary sensitivity from two studies: 92.6%, 95% CI 85.3% to 96.4%; specificity: 89.7%, 95% CI 78.8% to 95.3%; 153 participants; 95 cases) compared to primary staging (sensitivities from individual studies ranged from 30% to 47% and specificities from 73% to 88%), and was more sensitive than CT alone in both population groups, but participant numbers were very small.No conclusions can be drawn regarding routine imaging of the brain via MRI or CT. |
4 |
| 81. Marshall E, Romaniuk C, Ghaneh P, et al. MRI in the detection of hepatic metastases from high-risk uveal melanoma: a prospective study in 188 patients. British Journal of Ophthalmology. 97(2):159-63, 2013 Feb. |
Observational-Dx |
188 patients |
To evaluate MRI in the detection of asymptomatic hepatic metastases from uveal melanoma. |
Ninety (48%) of the 188 patients developed detectable metastases, a median of 18 months after ocular treatment. Six-monthly MRI-detected metastases before symptoms in 83 (92%) of 90 patients developing systemic disease, with 49% of these having less than five hepatic lesions all measuring less than 2 cm in diameter. Of these 90 patients, 12 (14%) underwent hepatic resection, all surviving for at least a year afterwards. |
3 |
| 82. Orcurto V, Denys A, Voelter V, et al. (18)F-fluorodeoxyglucose positron emission tomography/computed tomography and magnetic resonance imaging in patients with liver metastases from uveal melanoma: results from a pilot study. Melanoma Research. 22(1):63-9, 2012 Feb. |
Review/Other-Dx |
10 patients with biopsy-proven liver metastases of uveal melanoma |
To determine the value of FDG-PET/CT with respect to MRI at diagnosis and its potential for monitoring therapy. |
Overall, 108 liver lesions were seen: 34 (31%) on both modalities (1-18 lesions/patient), four (4%) by PET/CT only, and 70 (65%) by MRI only. SUV correlated with MRI lesion size (r=0.81, P<0.0001). PET/CT detected 26 of 33 (79%) MRI lesions of more than or equal to 1.2 cm, whereas it detected only eight of 71 (11%) lesions of less than 1.2 cm (P<0.0001). MRI lesions without PET correspondence were small (0.6±0.2 vs. 2.1±1.1 cm, P<0.0001). During follow-up (six patients, 30 lesions), the ratio lesion-to-normal-liver SUV diminished in size-stable lesions (1.90±0.64-1.46±0.50, P<0.0001), whereas it increased in enlarging lesions (1.56±0.40-1.99±0.56, P=0.032). |
4 |
| 83. Davanzo JM, Binkley EM, Bena JF, Singh AD. Risk-stratified systemic surveillance in uveal melanoma. British Journal of Ophthalmology. 103(12):1868-1871, 2019 12. |
Review/Other-Dx |
107 consecutive patients with primary uveal melanoma |
To analyse socioeconomic data from patients with uveal melanoma who underwent molecular prognostication to determine which variables influence adherence. |
High-risk patients were more likely to develop metastasis than low-risk/unknown-risk patients (p<0.001). High-risk patients were more likely to have scans at baseline (p=0.008) and to have expected scans relative to low-risk/unknown-risk patients (p<0.001). There was no significant relationship between the likelihood of adhering to recommended surveillance and the other variables analysed. |
4 |
| 84. Fogarty GB, Tartaguia C. The utility of magnetic resonance imaging in the detection of brain metastases in the staging of cutaneous melanoma. Clinical Oncology (Royal College of Radiologists). 18(4):360-2, 2006 May. |
Review/Other-Dx |
193 consecutive patients |
To retrospectively evaluate the use of brain magnetic resonance imaging (MRI) in the initial staging of patients with cutaneous melanoma in our melanoma unit. |
One hundred patients were eligible. No patients were upstaged by MRI. Of a total of 33 patients already graded as stage IV by prior staging, 11 (33%) were found to have brain metastases. No patients graded less than stage IV were found to have brain metastases on MRI. Six out of 12 patients with incidental symptoms had metastases. Five patients graded as stage IV had asymptomatic brain metastases. |
4 |
| 85. Alvarado GC, Papadopoulos NE, Hwu WJ, et al. Pelvic computed tomography scans for surveillance in patients with primary melanoma in the head and neck. Melanoma Research. 21(2):127-30, 2011 Apr. |
Review/Other-Dx |
146 patients |
To evaluate the value of pelvic CT scans in this patient population to date, suggests that the routine use of a pelvic CT scan as a surveillance method does not have any impact on the management in patients with primary melanoma in the head and neck. |
We identified 146 patients with either primary or mucosal primary melanoma who had adequate follow-up evaluation for at least 5 years at our institution. Among them, 33 patients (23%) had stage III melanoma, and four (3%) had stage IV melanoma at the time of diagnosis. At a median follow-up duration of 49 months, 110 patients (75%) had developed recurrences, and the median time to the first recurrence was 13 months. A total of 82 (56%) patients had eventually developed distant metastases, but only 10 (7%) had developed metastases in the pelvis, and none had developed pelvic metastases as the first and the only site of recurrence. If the true rate of finding the pelvic metastasis as the first and the only recurrence was at least 3%, the probability of seeing 0 events of the 146 patients was 1.17%. |
4 |
| 86. Etchebehere EC, Romanato JS, Santos AO, Buzaid AC, Camargo EE. Impact of [F-18] FDG-PET/CT in the restaging and management of patients with malignant melanoma. Nuclear Medicine Communications. 31(11):925-30, 2010 Nov. |
Review/Other-Dx |
78 patients |
To assess the impact of [F-18] FDG-PET/CT on the restaging and changing management of patients with malignant melanoma. |
In 27% of the patients the management was changed after the [F-18] FDG-PET/CT studies. Upstaging from locoregional recurrence to distant recurrence occurred in a striking 5 of 23 (22%) patients. The sensitivity, specificity and positive and negative predictive values for lesion detection were 95%, and accuracy was 94.9%. There were two false-positive and two false-negative studies. |
4 |
| 87. Albano D, Familiari D, Fornito MC, et al. Clinical and Prognostic Value of 18F-FDG-PET/CT in the Restaging Process of Recurrent Cutaneous Melanoma. Current Radiopharmaceuticals. 13(1):42-47, 2020. |
Observational-Dx |
74 patients surgically treated for CM that underwent 18F-FDG-PET/CT |
To evaluate the clinical and prognostic impact of 18F-FDG-PET/CT on the restaging process of cutaneous melanoma (CM) after surgery in patients with suspected distant recurrent disease or suspected metastatic progression disease. |
Suspicion of recurrent CM was confirmed in 24/27 patients with a positive 18F-FDG-PET/CT scan. Overall, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 18F-FDG-PET/CT were 82%, 93%, 88%, 89%, and 89%, respectively, with area under the curve being 0.87 (95%IC 0.78-0.97; p<0.05). 18F-FDG-PET/CT findings significantly influenced the therapeutic management in 18 patients (modifying therapy in 10 patients; guiding surgery in 8 patients). After 2 years of follow-up, PFS was significantly longer in patients with a negative vs. a positive 18F-FDG-PET/CT scan (90% vs 46%, p<0.05; Fig. 1). Moreover, a negative scan was associated with a significantly longer OS than a positive one (76% vs 39% after 2 years, p<0.05; Fig. 2). In addition, a positive 18F-FDG-PET/CT scan was associated with an increased risk of disease progression (HR=8.2; p<0,05). |
3 |
| 88. Forschner A, Olthof SC, Guckel B, et al. Impact of 18F-FDG-PET/CT on surgical management in patients with advanced melanoma: an outcome based analysis. European Journal of Nuclear Medicine & Molecular Imaging. 44(8):1312-1318, 2017 Aug. |
Observational-Tx |
333 patients with mainly stage III/IV melanoma that had PET/CT |
To evaluate the influence of 18F-FDG-PET/CT on clinical decision making and outcome in advanced melanoma patients planned for radical metastasectomy. |
In 28 of 107 patients (26%), the surgical treatment plan remained unchanged after PET/CT. In 24 patients (22%), minor changes were performed, such as enlargement or reduction of the surgical field. In 55 patients (51%, 95% CI 42%-61%) major changes of the intended treatment plan occurred; of those, 20 patients (19%) were classified to be tumor-free with PET/CT, 32 patients (30%) were found to have multiple previously unrecognized metastases and had to be treated by systemic therapy, three patients (3%) had to be changed to palliative radiotherapy or isolated extremity perfusion. The 1-year and 2-year overall survival (OS) in patients with complete metastasectomy (N = 52) was 90% and 79%, respectively. Systemically treated patients (N = 32) resulted in 1-year OS of 72% and 2-year OS of 61%. Eleven of 32 patients (34%) with systemic therapy experienced a complete response. Until December 2016, all 20 patients classified as tumor-free by PET/CT were alive. |
2 |
| 89. Lee JW, Nam SB, Kim SJ. Role of 18F-Fluorodeoxyglucose Positron Emission Tomography or Positron Emission Tomography/Computed Tomography for the Detection of Recurrent Disease after Treatment of Malignant Melanoma. Oncology. 97(5):286-293, 2019. |
Meta-analysis |
14 results
11 studies |
To investigate the diagnostic performance of 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) or PET/computed tomography (PET/CT) for the detection of recurrent disease after treatment of malignant melanoma (MM). |
Across 14 results from 11 studies, the pooled sensi-tivity for 18F-FDG-PET or PET/CT was 0.94 (95% confidence interval [CI] 0.90-0.97) with heterogeneity (I2 = 57.95) and a pooled specificity of 0.91 (95% CI 0.88-0.93) without heterogeneity (I2 = 27.24). LR syntheses gave an overall LR+ of 10.4 (95% CI 7.7-14.2) and an LR- of 0.06 (95% CI 0.04-0.11). The pooled diagnostic odds ratio was 162 (95% CI 94-280). The hierarchical SROC curve indicated that the area under the curve was 0.96 (95% CI 0.93-0.97). In meta-regression analysis, no definite variable was the source of the study heterogeneity. |
Good |
| 90. Mesnard C, Bodet-Milin C, Eugene T, Nguyen JM, Khammari A, Dreno B. Predictive value of FDG-PET imaging for relapse in metastatic melanoma patients treated with immunotherapy. Journal of the European Academy of Dermatology & Venereology. 34(10):2261-2267, 2020 Oct. |
Review/Other-Dx |
26 patients |
To determine whether FDG-PET imaging could be superior to CT scan in distinguishing residual tumours versus the absence of tumour in patients with a partial response (PR) or stable disease (SD) and whether a complete metabolic response (CMR) was associated with better outcomes. |
Twenty-six patients were in complete remission after collegial decision. Two patients had a SD on CT scan and a CMR on FDG-PET scan, and none of them relapsed. Ten patients had a PR on CT scan and a CMR on FDG-PET scan, and none of them relapsed. The mean treatment duration to achieve a complete remission was 7 months (3-23). A univariate analysis showed that a RFA assessed on the FDG-PET scan was significantly associated with a relapse (P = 0.00231). |
4 |
| 91. Singnurkar A, Wang J, Joshua AM, Langer DL, Metser U. 18F-FDG-PET/CT in the Staging and Management of Melanoma: A Prospective Multicenter Ontario PET Registry Study. Clinical Nuclear Medicine. 41(3):189-93, 2016 Mar. |
Review/Other-Dx |
319 consecutive patients with potentially resectable localized high-risk melanoma or recurrent disease |
To assess the impact of PET on staging and management of patients with high-risk or advanced melanoma. |
There was a significant increase in stage to M1 status after PET in 56 of 319 patients (17.6%) (P < 0.0001). There was no significant relationship between upstaging with PETand the proportion of patients receiving radiation therapy (P = 0.066) or systemic therapy (P = 0.072). There was a significant relationship between upstaging with PET and the proportion of patients undergoing surgical resection of metastases distant to the primary melanoma site (P = 0.034). |
4 |
| 92. Twycross SH, Burger H, Holness J. The utility of PET-CT in the staging and management of advanced and recurrent malignant melanoma. South African Journal of Surgery. 57(3):44-49, 2019 Sep. |
Review/Other-Tx |
39 patients |
To determine whether the use of PET-CT alters the initial staging and management of patients with advanced and recurrent melanoma. |
A change in stage grouping occurred in 21/39 (53.8%) of patients, 76.2% of which were up-staged and 23.8% down staged. On analysis of stage III/IV and recurrent melanoma, a change in stage occurred in 90% of stage III, 50% of stage IV and 50% of recurrent melanoma patients. This effected a change in management in 86.7% of patients with stage III, IV and recurrent melanoma collectively. |
4 |
| 93. Kurli M, Reddy S, Tena LB, Pavlick AC, Finger PT. Whole body positron emission tomography/computed tomography staging of metastatic choroidal melanoma. American Journal of Ophthalmology. 140(2):193-9, 2005 Aug. |
Review/Other-Tx |
20 patients with suspected metastatic choroidal melanoma |
To evaluate whole-body positron emission tomography (PET)/computed tomography in staging of patients with metastatic choroidal melanoma. |
Twenty patients underwent PET/computed tomography. Eighteen were imaged because of abnormal clinical, hematologic, or radiographic screening studies during the course of their follow-up after plaque brachytherapy or enucleation. Two were imaged before treatment of their primary tumor. PET/computed tomography revealed or confirmed metastatic melanoma in eight (40%) of these 20 patients. The mean time from initial diagnosis to metastasis was 47 months (range 0 to 154). The most common sites for metastases were the liver (100%), bone (50%), lung (25%), lymph nodes (25%), and subcutaneous tissue (25%). Cardiac, brain, thyroid, and posterior abdominal wall lesions (12.5%) were also noted. Six patients (75%) had multiple organ involvement. No false positives were noted. PET/computed tomography imaging also detected benign lesions of the bone and lymph nodes in three patients (15%). All patients had hepatic metastases and liver enzyme assays were abnormal in only one (12.5%) of eight patients. |
4 |
| 94. Francken AB, Fulham MJ, Millward MJ, Thompson JF. Detection of metastatic disease in patients with uveal melanoma using positron emission tomography. European Journal of Surgical Oncology. 32(7):780-4, 2006 Sep. |
Observational-Dx |
22 patients with uveal melanoma (UM) |
To determine whether FDG-PET would detect either unsuspected sites of metastatic disease in patients with UM or confirm negative findings, which might affect management. |
FDG-PET was performed in 22 patients with UM between April 1993 and March 2003. The presence of at least one focus of metastatic melanoma was confirmed in 14 of 18 patients with positive FDG-PET, and three of four negative FDG-PET studies were confirmed. LMs were demonstrated by FDG-PET in 17 patients. In 15 of these patients this finding was confirmed with anatomical imaging. In two patients LMs indicated by FDG-PET initially appeared to be false positive, but in one of them the diagnosis was confirmed after longer follow-up. Seven of the confirmed lesions were isolated LMs. For LMs FDG-PET showed sensitivity, specificity and accuracy of 100%, 67% and 90% respectively, a positive predictive value of 88% and a negative predictive value of 100%. |
3 |
| 95. Servois V, Mariani P, Malhaire C, et al. Preoperative staging of liver metastases from uveal melanoma by magnetic resonance imaging (MRI) and fluorodeoxyglucose-positron emission tomography (FDG-PET). European Journal of Surgical Oncology. 36(2):189-94, 2010 Feb. |
Experimental-Dx |
15 patients |
To compare the sensitivity of dynamic-enhanced magnetic resonance imaging (MRI) with fluorodeoxyglucose-positron emission tomography (FDG-PET) in the preoperative diagnosis of liver metastases from uveal melanoma. |
R0 resection was performed in 12 patients. A total of 28 lesions were resected with 27 histologically proven metastases. Nine lesions were smaller than 5mm, 7 measured 5-10mm and 11 were larger than 10mm. Sensitivity and positive predictive value were 67% and 95% for MRI compared to 41% and 100% for FDG-PET. The difference between the two modalities was statistically significant (p=0.01; McNemar test). In remaining 3 patients, diffuse miliary disease (>10 capsular lesions) was discovered intraoperatively, and was suspected on preoperative MRI in 2 cases. Only one extrahepatic lesion identified by FDG-PET was falsely positive. |
2 |
| 96. Foti PV, Travali M, Farina R, et al. Diagnostic methods and therapeutic options of uveal melanoma with emphasis on MR imaging-Part I: MR imaging with pathologic correlation and technical considerations. Insights Imaging. 2021 Jun 03;12(1):66. |
Review/Other-Dx |
N/A |
To provide the radiologists with awareness about diagnostic methods and therapeutic options of uveal melanoma. In the present first section we summarize the MR anatomy of the eye and describe ophthalmological and radiological imaging techniques to diagnose uveal melanomas, with emphasis on the role of MR imaging. |
No results stated in abstract. |
4 |
| 97. Solnik M, Paduszynska N, Czarnecka AM, et al. Imaging of Uveal Melanoma-Current Standard and Methods in Development. Cancers (Basel). 2022 Jun 27;14(13):3147. |
Review/Other-Dx |
N/A |
To review imaging modalities currently used in the diagnostics of uveal melanoma, including fundus imaging, ultrasonography (US), optical coherence tomography (OCT), single-photon emission computed tomography (SPECT), fundus fluorescein angiography (FFA), indocyanine green angiography (ICGA), fundus autofluorescence (FAF), as well as positron emission tomography/computed tomography (PET/CT) or magnetic resonance imaging (MRI). |
No results stated in abstract. |
4 |
| 98. Cohen VML, Pavlidou E, DaCosta J, et al. Staging Uveal Melanoma with Whole-Body Positron-Emission Tomography/Computed Tomography and Abdominal Ultrasound: Low Incidence of Metastatic Disease, High Incidence of Second Primary Cancers. Middle East African journal of ophthalmology. 25(2):91-95, 2018 Apr-Jun. |
Review/Other-Dx |
108 patients with uveal melanoma staged with FDG PET/CT and abdominal ultrasound |
To report the results of staging primary uveal melanoma with whole-body (18) fluorodeoxyglucose (FDG) positron-emission tomography/computed tomography (PET/CT) and abdominal ultrasound. |
Over 2 years, 108 patients with medium-to-large melanoma underwent dual imaging. According to the tumor, node, and metastasis classification, there were 75% T3, 11% T2, and 14% T1 uveal melanomas. Only, three of 108 patients (2.8%) were found to have metastatic uveal melanoma. All three had liver metastases confirmed following biopsy; one of three had additional extrahepatic widespread metastases. In these three patients, liver findings using both imaging techniques were consistent in one patient. In the second case, abdominal ultrasound missed the diagnosis of metastatic disease; however, FDG PET/CT revealed intense metabolic activity of the liver. In the third case, PET/CT missed the liver metastases; however, this was identified on abdominal ultrasound. PET/CT identified incidental second primary malignancies in 10 patients (9%). Second malignancies were found in the lung, breast, colon, thyroid, and adrenal gland. Abdominal ultrasound detected benign hepatic abnormalities in 20 patients (18%). |
4 |
| 99. Finger PT, Kurli M, Reddy S, Tena LB, Pavlick AC. Whole body PET/CT for initial staging of choroidal melanoma. British Journal of Ophthalmology. 89(10):1270-4, 2005 Oct. |
Review/Other-Dx |
52 patients |
To investigate the value of whole body positron emission tomography/computed tomography (PET/CT) in screening for metastatic choroidal melanoma in patients initially diagnosed with choroidal melanoma. |
Two of 52 (3.8%) patients were found to have metastatic melanoma before treatment. The most common sites for metastases were the liver (100%), bone (50%), and lymph nodes (50%). Brain involvement was also present in one patient. One patient (50%) had involvement of multiple sites. Haematological liver enzyme assays were normal in both patients. PET/CT showed false positive results in three patients (5.7%) when further evaluated by histopathology and/or additional imaging. In seven patients (13.4%) PET/CT imaging detected benign lesions in the bone, lung, lymph nodes, colon, and rectum. |
4 |
| 100. Freton A, Chin KJ, Raut R, Tena LB, Kivela T, Finger PT. Initial PET/CT staging for choroidal melanoma: AJCC correlation and second nonocular primaries in 333 patients. European Journal of Ophthalmology. 22(2):236-43, 2012 Mar-Apr. |
Review/Other-Dx |
333 patients |
To report on whole body positron emission tomography/computed tomography (PET/CT) screening for metastasis at diagnosis of primary uveal melanoma. |
Using the American Joint Committee on Cancer (AJCC) tumor, node, metastasis (TNM) 7th edition criteria, 104 tumors were classified T1 (31%), 162 T2 (49%), 37 T3 (11%), and 30 T4 (9%). Seven of 333 (2.1%; 95% confidence interval [CI] 0.8-4.3) patients had metastatic melanoma. One tumor was a T3 and 6 were T4. Thus, 3% of T3 and 20% of T4 melanomas were found to have metastases at the time of initial diagnosis. Ten patients (3.3%; 95% CI 0.9-5.5) had synchronous second cancers and 28 (8.4%) concurrent benign lesions. The most common metastatic sites were liver (7/7) and bone (2/7). |
4 |
| 101. Kurli M, Chin K, Finger PT. Whole-body 18 FDG PET/CT imaging for lymph node and metastatic staging of conjunctival melanoma. British Journal of Ophthalmology. 92(4):479-82, 2008 Apr. |
Review/Other-Dx |
14 patients |
To evaluate 18-fluoro-2-deoxyglucose (FDG) whole-body positron emission tomography/computed radiographic tomography (PET/CT) for lymph node and metastatic staging of patients with conjunctival melanoma. |
Fourteen patients with conjunctival melanoma underwent PET/CT imaging. Seven were newly diagnosed (presurgical screening), and seven had undergone prior treatment (follow-up group). Only one patient with conjunctival melanoma (7.1%) was found to have metastatic disease on PET/CT imaging. Abnormal foci were found in the liver, lung, peritoneal cavity, lumbar spine as well as a supraclavicular node (T4N1M4). All liver function tests were normal. The mean length of follow-up after PET/CT imaging was 13 months (range 4-30 months). |
4 |
| 102. Rantala ES, Peltola E, Helminen H, Hernberg M, Kivela TT. Hepatic Ultrasonography Compared With Computed Tomography and Magnetic Resonance Imaging at Diagnosis of Metastatic Uveal Melanoma. American Journal of Ophthalmology. 216:156-164, 2020 08. |
Review/Other-Dx |
215 patients |
To evaluate the consistency of hepatic ultrasonography (US) with staging computed tomography (CT) and magnetic resonance imaging (MRI), to analyze why US was inconsistent with CT/MRI, and to compare CT/MRI. |
The enrolled patients underwent 215 US, 167 CT, and 69 MRI examinations, and 67% of them had biopsy-confirmed metastases. Screening was regular for 98% of the patients, and 66% were asymptomatic. US was fully consistent with CT/MRI in detecting metastases in 113 (53%) patients, in 63 (29%) CT/MRI showed more metastases, and in 16 (7%) CT/MRI showed fewer metastases than US. CT/MRI was inconsistent with US in 23 (11%) patients. The sensitivity of US in detecting metastases was 96% (95% confidence interval, 92-98). US failed to suggest metastases in 10 patients. LFT were abnormal in 6 of them, and a newly detected hepatic lesion was present by US in 4. |
4 |
