Navigation-assisted localisation and resection of subclinical metastatic malignant melanoma of unknown primary based on 18-fluorodeoxyglcose positron emission tomography computed tomography fusion imaging.
A technical application using a stereotactic navigation system with fusion images of [18F]-2-fluorodeoxyglucose (FDG) positron tomography and computed tomography (PET-CT) in the case of a metastatic melanoma of unknown primary site is described. A 50-year-old woman presented with a slow, growing level V neck lump which was cytologically proved to be a metastatic melanoma despite the absence of prior or existing history of skin malignancy. Whilst detailed physical examination failed to yield the site of the primary lesion, full body FDG-PET images isolated FDG-avid subclinical scalp lesions. Fused PET-CT data provided the navigation system with accurate localisation of the subclinical metastatic lesion. Histopathological examination of the navigation-guided resection specimen confirmed that the lesion was excised with acceptable margins. This case illustrates the feasibility of navigation-assisted resection of a subclinical malignant melanoma lesion and may have a role to play in the management of the melanoma of unknown primary.
Maxillofacial Unit, Queen Victoria Foundation Hospital, East Grinstead, United Kingdom. naseemghazali@gmail.com
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N
Ghazali
J C
JC
Collyer
J
J
Tighe
D005260:Female; D019788:Fluorodeoxyglucose F18; D006258:Head and Neck Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary / Q000601:surgery; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D008197:Lymph Node Excision / Q000379:methods; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging / Q000473:pathology*; D008545:Melanoma / Q000000981:diagnostic imaging / Q000556:secondary* / Q000601:surgery; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods*; D037981:Neck Dissection / Q000379:methods; D009382:Neoplasms, Unknown Primary / Q000000981:diagnostic imaging; D049268:Positron-Emission Tomography; D019275:Radiopharmaceuticals; D012535:Scalp / Q000000981:diagnostic imaging / Q000601:surgery; D012878:Skin Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary / Q000601:surgery; D025321:Surgery, Computer-Assisted / Q000295:instrumentation / Q000379:methods; D014057:Tomography, X-Ray Computed; D051598:Whole Body Imaging / Q000379:methods
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18