Abstract
Malignant Melanoma (MM) accounts only for 4% of all skin cancers, but is the most aggressive and lethal type of skin cancer. MM metastizes either to regional lymph nodes or to distant sites following predictable or unpredictable pathways. Nuclear Medicine (NM) plays a key role in nodal staging with the use of sentinel lymph node (SLN) mapping and guided sampling techniques. 18F-Fluorodeoxyglucose (18F-FDG) Positron Emission Τomography (PET) has also a pivotal role in staging and restaging of MM and can alter significantly patient’s management. In today’s clinical practice, hybrid SPECT/CT and PET/CT scanners allow simultaneous assessment of both metabolic and anatomic characteristics of the primary tumor and its potential local, regional, and distant extension. More studies are required to determine the optimal surveillance schedules of PET/CT in patients with high-risk MM in order to maximize the detection of early relapse, as well as the role of PET/CT in the assessment of response to MM therapy. In this paper, we review the clinical contribution of current nuclear medicine technologies to the management of MM.
Highlights
Nuclear imaging is based on the injection of radionuclides in their native form or as a part of a chemical molecule following the tracer principle, which basically means that very minute amounts of active substances are used without disturbing vital biological processes
The results showed that all patients treated at potentially therapeutic levels had at least a partial metabolic response (PMR), and three patients achieved a complete metabolic response (CMR).There was a positive correlation between the percentage of injected dose and reduction in the maximum standardized uptake value (SUVmax) of target lesions that indicated a significant homogeneity of the response between lesions in individual patients
sentinel lymph node biopsy (SLNB) is the mainstay in melanoma staging while the role of PET/computed tomography (CT) even in earlier stages is evolving rapidly
Summary
Nuclear imaging is based on the injection of radionuclides in their native form or as a part of a chemical molecule following the tracer principle, which basically means that very minute amounts of active substances are used without disturbing vital biological processes. The strengths of nuclear imaging are its high sensitivity, the increased number of clinical scanners installed and a wide variety of targeted, radioactively labeled tracers in clinical applications. Nuclear medicine techniques, such as sentinel lymph node (SLN) mapping and 18F-fluorodeoxyglucose (18F-FDG) Positron Εmission Τomography (PET), have played key roles in nodal and distant staging of malignant melanoma (MM). The mass of positron and electron is converted into two 511 keV photons that travel in approximately opposite directions Coincidence detection of these annihilation photons followed by mathematical reconstruction of the images form the basis of PET imaging. Two or more SLNs are identified in different basins; all of them have to be excised and sent for biopsy (Figure 1)
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