Initial Staging of Clinically Localized Disease

In intermediate- and high-risk lesions greater than 1 mm in thickness, assessment of the SLN draining the tumor site is very important. Rinne et al.357 studied 52 patients with primary melanoma greater than 1.5 mm in depth who had no evidence of local or distant metastases; they found that the accuracy of PET for identification of regional or distant metastases was 95% per lesion and 94% per patient and that for CT was 68% per lesion and 77% per patient.

Macfarlane et al.358 found that PET accurately predicted regional nodal status in 88% of 23 patients with primary melanoma more than 1.5 mm thick. Wagner et al.359 performed a large prospective trial containing 70 patients with primary thick melanoma (more than 1.0 mm) and 4 patients with recurrent melanoma in or adjacent to the surgical scar who underwent PET and SLN biopsy. They demonstrated a sensitivity of 11% to 17% (depending on reading threshold) and a specificity of 94% to 100%. This is one of the first articles to suggest that PET is not sensitive for staging regional nodes in patients with newly diagnosed thick melanomas.

Acland et al.360 found that FDG-PET failed to identify all 14 positive SLNs found in 50 patients who underwent sentinel node biopsy for primary melanomas more than 1 mm in thickness. Fink et al.361 found, in 48 patients with stage I or II disease, that FDG-PET identified only one metastatic node, and they concluded that this result was likely "due to the small size of the metastatic deposits in the sentinel node."

There is now strong evidence that FDG-PET is not useful in the initial staging of primary melanoma when there is no clinical evidence of local or distant metastatic spread. This finding is attributed to the small size of most nodal metastases and the low prevalence of nodal disease in patients with primary melanoma.

How To Prevent Skin Cancer

How To Prevent Skin Cancer

Complete Guide to Preventing Skin Cancer. We all know enough to fear the name, just as we do the words tumor and malignant. But apart from that, most of us know very little at all about cancer, especially skin cancer in itself. If I were to ask you to tell me about skin cancer right now, what would you say? Apart from the fact that its a cancer on the skin, that is.

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