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Few patients with thick melanoma may benefit from preoperative PET/CT
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NEW YORK — Treatment plans for patients with thick melanoma can change based on findings from preoperative PET/CT, according to results of a retrospective cohort study presented at HemOnc Today Melanoma and Cutaneous Malignancies.
Still, a majority of patients will not have any findings to alter management, results showed.
“Although studies have shown a low yield for identification of regional or distant metastases by preoperative PET/CT for thin and intermediate-thickness melanoma, the utility of preoperative PET/CT in patients with thick melanomas remains unknown,” Neha Goel, surgical oncology fellow at Fox Chase Cancer Center, and colleagues wrote.
Goel and colleagues sought to determine the clinical impact of PET/CT for initial staging in 178 patients (mean age, 69 years; 97% white) with thick T4 melanomas or stage 3 disease (mean thickness, 5.13 mm; range, 0.37-25). Most patients had lymphovascular invasion (69%), at least one mitosis (96%) and ulceration (92%).
All patients had an initial PET/CT. The scans identified 11 patients with regional metastatic disease, 10 of whom had regional metastatic disease on final pathology.
The sensitivity of PET/CT in regional metastatic disease was 14%, and specificity was 88%.
In terms of distant metastatic disease, PET/CT identified one patient with pulmonary metastasis who had a negative chest CT. However, one patient with anal melanoma had an intraoperative finding of liver metastasis that was not identified on PET/CT.
Sensitivity of PET/CT in distant metastatic disease was 0% and specificity was 99%.
Two of these patients underwent completion lymph node dissection, and one patient underwent systemic therapy.
Researchers noted that nine patients had incidental colon, thyroid, parotid and cerebellar pathology. One patient had a cecal mass with high-grade dysplasia that required a hemicolectomy, whereas the others had benign pathology.
“The melanoma-related treatment plan was altered in three (4%) patients,” the researchers wrote. “Our study suggests that patients with thick melanoma can benefit from a preoperative PET/CT, although the majority of patients will not have any findings to alter management.” – by Alexandra Todak
Reference:
Goel N, et al. Preoperative PET/CT and clinical decision making in patients with thick (T4 and stage 3) melanomas. Presented at: HemOnc Today Melanoma and Cutaneous Malignancies; March 24-25, 2017; New York.
Disclosure: HemOnc Today could not confirm the researchers’ relevant financial disclosures at the time of reporting.