ArticleAnnals of surgical oncology2025
The Utility of Preoperative PET/CT in Patients with Clinically High-Risk Melanoma.
Article in Annals of surgical oncology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundMelanoma is a lethal skin cancer and accounts for the highest mortality rate caused by cutaneous malignancies. Prognosis is dependent on stage. Patients with "thick" melanomas of 4-mm Breslow depth or greater are at increased risk for nodal metastases. Positron emission tomography/computed tomography (PET/CT) may be an underutilized imaging study for preoperative clinical staging in those with T4 melanoma. PATIENTS AND
methodsThis was a single-institution retrospective analysis of adult patients with biopsy-proven T4 predominantly cutaneous melanoma (> 4 mm tumor thickness) who underwent preoperative PET/CT at a single National Cancer Institute (NCI)-designated cancer center between 1 January 2010 and 30 December 2022. Patients were excluded if there was clinical evidence of locoregional or distant metastatic disease at time of preoperative PET/CT.
resultsA total of 94 patients met inclusion criteria. They were predominantly male (n = 56, 59.6%) and Caucasian (n = 83, 94.3%) with an average body mass index (BMI) of 27.97 and median age of 69.5 years. A total of 69.7% of patients had tumor ulceration on biopsy and 2% had microsatellitosis. Positive PET/CT scans were found in eight patients (8.5%), which changed clinical management in seven of the eight patients. When comparing PET/CT results to sentinel lymph node biopsy (SLNB) results, sensitivity was 15.4%, specificity was 94.1%, positive predictive value was 50%, and negative predictive value was 74.4%.
conclusionsPatients with T4 melanoma without clinical suspicion of nodal disease do not have a high rate of occult metastases on preoperative PET/CT. We argue that clinical exam remains the most important tool for preoperative workup in these patients, but that PET/CT may be considered on the basis of patient-specific factors.
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