title: Is there an added clinical value of "true"whole body(18)F-FDG PET/CT imaging in patients with malignant melanoma?
abstract: Accurate and reliable staging of disease extent in patients with malignant MM is essential to ensure appropriate treatment planning. The detection of recurrent or residual malignancy after primary treatment is important to allow for early intervention and to optimise patient survival. 2-deoxy-2-[(18)F]fluoro-D-glucose ((18)F-FDG) PET or PET computed tomography (PET/CT) is indicated for surveillance of malignant MM due to its high sensitivity and specificity for soft-tissue or nodal recurrences and metastases.  It has been claimed that including lower extremities and skull in addition to 'eyes to thigh' images in PET/CT evaluation  of metastatic MM routinely is warranted. We have studied retrospectively the reports of whole-body PET/CT scans in all patients  with MM scanned in our Department from April 2005 to December 2010. All PET abnormalities in the brain/scalp and lower  extremities were tabulated by location and whether they were 'expected' or 'unexpected'. Findings were correlated  with pathology, other imaging studies, and clinical follow-up. In this study, 398 PET/CT examinations in 361 patients with MM  were included. Results showed that twelve of the 398 (3%) scans had brain/scalp abnormalities, with only 4 (1.0%) showing  unexpected abnormalities. Twenty nine of the 398 (7.2%) scans showed lower extremity abnormalities, with only 5 (1.2%)  showing unexpected abnormalities. In no case was an isolated unexpected malignant lesion identified in the brain/scalp or  lower extremities. In conclusion, whole body PET/CT scan showed about 1% unexpected primary or metastatic MM lesions  involving the head or lower extremities, which seldom offered significant additional clinical benefit and were unlikely to change  clinical management. No clinically significant change in staging would have occurred. Routine 'eyes to thighs' images were  adequate for this subset of patients.
authors.affiliation: Department of Nuclear Medicine, PET and Bone Densitometry, Level 7, Theatre Block Royal Adelaide Hospital, North Terrace, Adelaide 5000, Australia.
authors.forename: Julie C
authors.initials: JC
authors.lastname: Tan
authors.forename: Barry E
authors.initials: BE
authors.lastname: Chatterton
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia / Q000453:epidemiology; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008297:Male; D008545:Melanoma / Q000175:diagnosis* / Q000453:epidemiology*; D008875:Middle Aged; D064847:Multimodal Imaging / Q000706:statistics & numerical data*; D049268:Positron-Emission Tomography; D015995:Prevalence; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012878:Skin Neoplasms / Q000175:diagnosis* / Q000453:epidemiology*; D014057:Tomography, X-Ray Computed; D051598:Whole Body Imaging / Q000706:statistics & numerical data*
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18