Non-Cutaneous Melanoma, Findings and Prognostic Value of FDG PET/CT: A Case Series of 23 patients and review of the literature

Document Type : Original Article

Authors

Research Center for Nuclear Medicine, Tehran University of Medical Sciences, Tehran, Iran

Abstract

Objective(s): Non-cutaneous malignant melanomas (NCM) are rare malignancies. Due to their nonspecific symptoms, they present later in life. The value of FDG PET/CT in this group of patients is not clear. The aim of this study is to assess the role of FDG PET/CT in the management of NCM and its prognostic implication.
Methods: We retrospectively selected twenty-three patients with a diagnosis of NCM evaluated with FDG PET/CT in Shariati hospital between 2019 and 2021. The PET/CT data were reviewed and compared with available conventional imaging findings. Five patients died within five months. The surviving patients were followed within a time interval of 7 to 27.5 months after their PET/CT study, regarding their disease status.
Results: Among 23 patients (8 ocular, 5 sinonasal, 3 pharyngeal, 2 anorectal, 2 vulvovaginal, and 3 unknown primaries), PET/CT was able to detect residual primary disease, assess treatment response, and reveal or exclude metastases. Additional lesions compared to conventional imaging were found in five, while in one with brain metastases PET/CT was unable to detect lesions on MRI.  Thirteen patients had negative PET/CT finding of which 11 (85%) did not have remarkable finding on follow-up. Metastatic disease was recognized in eight. Patients with extensive metastases on FDG PET/CT had a poorer outcome.
Conclusion: Similar to cutaneous melanoma, PET/CT is valuable in the management of NCM patients and is superior to conventional imaging modalities, with the exception of brain metastases. Patients with negative PET/CT findings have a better outcome as opposed to patients with significant positive PET/CT findings.

Keywords

References

  1. Wong VK, Lubner MG, Menias CO, Mellnick VM, Kennedy TA, Bhalla S, et al. Clinical and imaging features of noncutaneous melanoma. AJR Am J Roentgenol. 2017; 208(5):942-959.
  2. Murphy G, Hussey D, Metser U. Non-cutaneous melanoma: is there a role for 18F-FDG PET-CT? Br J Radiol. 2014; 87 (1040): 20140324.
  3. Gilain L, Houette A, Montalban A, Mom T, Saroul N. Mucosal melanoma of the nasal cavity and paranasal sinuses. Eur Ann Otorhinolaryngol Head Neck Dis. 2014; 131(6):365-359.
  4. Murphy G, Hussey D, Metser U. PET-CT in noncutaneous melanoma. J Nucl Med. 2014; 55(supplement 1):1353.
  5. Isiklar I, Leeds NE, Fuller GN, Kumar AJ. Intracranial metastatic melanoma: correlation between MR imaging characteristics and melanin content. AJR Am J Roentgenol. 1995; 165(6):1503-1512.
  6. Perng P, Marcus C, Subramaniam RM. 18F-FDG PET/CT and melanoma: staging, immune modulation and mutation-targeted therapy assessment, and prognosis. AJR Am J Roentgenol. 2015; 205(2):259-270.
  7. Crippa F, Leutner M, Belli F, Gallino F, Greco M, Pilotti S, et al. Which kinds of lymph node metastases can FDG PET detect? A clinical study in melanoma. J Nucl Med. 2000; 41(9):1491-1494.
  8. Pfister DG, Spencer S, Adelstein D, Adkins D, Anzai Y, Brizel DM, et al. NCCN Guidelines Version 3.2021 Head and Neck Cancers NCCN Evidence BlocksTM. J Natl Compr Cancer Netw. 2021.
  9. Egberts F, Bergner I, Krüger S, Haag J, Behrens HM, Hauschild A, et al. Metastatic melanoma of unknown primary resembles the genotype of cutaneous melanomas. Ann Oncol. 2014; 25(1):246-50.
  10. Carvajal RD, Spencer SA, Lydiatt W. Mucosal melanoma: a clinically and biologically unique disease entity. J Natl Compr Canc Netw. 2012; 10(3):345-56.
  11. Matsuo T, Ogino Y, Ichimura K, Tanaka T, Kaji M. Clinicopathological correlation for the role of fluorodeoxyglucose positron emission tomography computed tomography in detection of choroidal malignant melanoma. Int J Clin Oncol. 2014; 19(2): 230-239.
  12. Sharma RS, Shah PK, Narendran V. Poor uptake of fluorodeoxyglucose in positron emission tomography-computed tomography scan for intraocular choroidal melanoma in Asian Indian eyes. World J Nucl Med. 2016; 15(1):53.
  13. Finger PT, Kurli M, Reddy S, Tena LB, Pavlick AC. Whole body PET/CT for initial staging of choroidal melanoma. Br J Ophthalmol. 2005; 89(10):1270-1274.
  14. Kalemaki MS, Karantanas AH, Exarchos D, Detorakis ET, Zoras O, Marias K, et al. PET/CT and PET/MRI in ophthalmic oncology (Review). Int J Oncol. 2020; 56(2):417-429.
  15. Strobel K, Bode B, Dummer R, Veit-Haibach P, Fischer DR, Imhof L, et al. Limited value of 18F-FDG PET/CT and S-100B tumour marker in the detection of liver metastases from uveal melanoma compared to liver metastases from cutaneous melanoma. Eur J Nucl Med Mol Imaging. 2009; 6(11):1774-1782.
  16. Kurli M, Reddy S, Tena LB, Pavlick AC, Finger PT. Whole body positron emission tomography/ computed tomography staging of metastatic choroidal melanoma. Am J Ophthalmol. 2005; 140(2):193-199.
  17. Freton A, Chin KJ, Raut R, Tena LB, Kivelä T, Finger PT. Initial PET/CT staging for choroidal melanoma: AJCC correlation and second nonocular primaries in 333 patients. Eur J Ophthalmol. 2012; 22(2): 236-43.
  18. Haerle SK, Soyka MB, Fischer DR, Murer K, Strobel K, Huber GF, et al. The value of 18F-FDG-PET/CT imaging for sinonasal malignant melanoma. Eur Arch Otorhinolaryngol. 2012; 269(1):127-133.
  19. Agrawal A, Pantvaidya G, Murthy V, Prabhash K, Bal M, Purandare N, et al. Positron emission tomography in mucosal melanomas of head and neck: Results from a South Asian tertiary cancer care center. World J Nucl Med. 2017; 16(3):197.
  20. Umeda M, Komatsubara H, Shigeta T, Ojima Y, Minamikawa T, Shibuya Y, et al. Treatment and prognosis of malignant melanoma of the oral cavity: preoperative surgicalprocedure increases risk of distant metastasis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008; 106(1):51-57.
  21. Mohan M, Sukhadia VY, Pai D, Bhat S. Oral malignant melanoma: systematic review of literature and report of two cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2013; 116 (4):e247-e254.
  22. Warszawik-Hendzel O, Słowińska M, Olszewska M, Rudnicka L. Melanoma of the oral cavity: pathogenesis, dermoscopy, clinical features, staging and management. J Dermatol Case Rep. 2014; 8(3):60.
  23. Xiao J, Su M, Wang D. Primary Malignant Melanoma of the Oropharynx Presented on 18F-FDG PET/CT. Clin Nucl Med. 2021; 46(9):741-743.
  24. Quan SH. Anal cancers: squamous and melanoma. Cancer. 1992; 70(5 Suppl): 1384-1389.
  25. Weyandt GH, Eggert AO, Houf M, Raulf F, Bröcker EB, Becker JC. Anorectal melanoma: surgical management guidelines according to tumour thickness. Br J Cancer. 2003; 89 (11):2019-2022.
  26. Bulut N, Dagıstanlı S, Yılmaz B, Atay OF. Surgical approach to anorectal melanoma with PET-CT staging: a case report. Surg J (N Y). 2017; 3(4): e177-e180.
  27. Kochhar R, Plumb AA, Carrington BM, Saunders M. Imaging of anal carcinoma. AJR Am J Roentgenol. 2012; 199(3):W335-344.
  28. Li Z-G, Qin X-J. Primary anorectal melanoma on FDG PET/CT. Clin Nucl Med. 2014; 39(8):762-764.
  29. Vishnoi MG, Sharma A, Ranjan R, Jain A, Kumar N. A rare case of primary malignant melanoma of cervix with metastasis to inguinal lymph node detected on 18F-FDG PET-CT scan. Iranian Journal of Nuclear Medicine. 2021; 29(2):111-113.
  30. Tsai YJ, Shueng PW, Chan SC, Chuang WY, Shiau YC, Hsu CH. Uterine cervical melanoma presenting with rapid progression detected by PET/CT. Acta Radiol Short Rep. 2012;1(4): 1-3.
  31. Rapi V, Dogan A, Schultheis B, Hartmann F, Rezniczek GA, Tempfer CB. Melanoma of the Vagina: Case Report and Systematic Review of the Literature. Anticancer Res. 2017; 37(12): 6911-6920.
  32. Ragnarsson-Olding BK, Kanter-Lewensohn LR, Lagerlöf B, Nilsson BR, Ringborg UK. Malignant melanoma of the vulva in a nationwide, 25‐year study of 219 Swedish females: clinical observations and histo-pathologic features. Cancer. 1999; 86(7): 1273-84.
Asia Oceania Journal of Nuclear Medicine and Biology
Volume 10, Issue 2
June 2022
Pages 91-99

Files

Share

How to cite

Statistics