PET for melanoma – pro
Medicare currently covers PET for initial staging of melanoma although it states, “CMS guidelines state that PET would rarely be used in the diagnosis of melanoma; CMS does not cover PET for evaluation of regional nodes when there is not suspicion for more extensive disease”. NCCN does list PET as a staging option. The most recent review concluded: “PET scanning facilitates the appropriate management of high-risk melanoma patients being considered for operative intervention. PET imaging in addition to CT scanning should be strongly considered before operation in patients at high risk for occult metastatic disease.”
There is less information on restaging, although Medicare covers that as well.
A Consensus Meeting was held in 2008 and the resulting 2009 guideline concluded:
Diagnosis/Staging
- Positron emission tomography (PET) is recommended for staging of high-risk patients with potentially resectable disease.
- PET is not recommended for the diagnosis of sentinel lymph node micrometastatic disease or for staging of I, IIa, or IIb melanoma.
- The routine use of PET or positron emission tomography/computed tomography (PET/CT) is not recommended for the diagnosis of brain metastases.
- The routine use of PET is not recommended for the detection of primary uveal malignant melanoma.
Assessment of Treatment Response
A recommendation cannot be made for or against the use of PET for the assessment of treatment response in malignant melanoma due to insufficient evidence.
A recommendation cannot be made for or against the use of PET for routine surveillance due to insufficient evidence.
Solitary Metastasis Identified at Time of Recurrence
PET is recommended for isolated metastases at time of recurrence or when contemplating metastasectomy. It also recommends CT or PET/CT for initial assessment of metastatic disease, which is what is planned here. (ME-1-)
2011 NCCN incorporates PET/CT into its followup recommendations. For stages 0-IIA it recommends reimaging with CT or PET/CT only for specific signs or symptoms. For stage IIB-IV disease it recommends. “consider chest-X-ray, CT or PET/CT every 6-12 months to screen for recurrent or metastatic disease, for up to 5 years. Francken et al proposed a new follow-up schedule was proposed: stage I annually, stage IIA 6-monthly for 2 years and then annually, stage IIB-IIC 4-monthly for 2 years, 6-monthly in the third year and annually thereafter.
Morton RL, Craig JC, Thompson The role of surveillance chest X-rays in the follow-up of high-risk melanoma patients. Ann Surg Oncol. 2009;16(3):571.
Francken AB, Accortt NA, Shaw HM, Colman MH, Wiener M, Soong SJ, Hoekstra HJ, Thompson, Follow-up schedules after treatment for malignant melanoma. Br J Surg. 2008;95(11):1401
Petrella T, Walker-Dilks C. PET imaging in melanoma: recommendations. Toronto (ON): Cancer Care Ontario (CCO); 2009 Jan 19. 24 p. (Recommendation report – PET; no. 3). [19 references]
Vereecken P, Laporte M, Petein M, Steels E, Heenen M. Evaluation of extensive initial staging procedure in intermediate/high-risk melanoma patients.
J Eur Acad Dermatol Venereol. 2005 Jan;19(1):66-73.
T, Coleman JJ 3rd, Hutchins G, Love C, Wenck S, DaggyWagner JD, Schauwecker D, Davidson D, Logan Inefficacy of F-18 fluorodeoxy-D-glucose-positron emission tomography scans for initial evaluation in early-stage cutaneous melanoma.Cancer. 2005 Aug 1;104(3):570-9.
Swetter SM, Carroll LA, Johnson DL, Segall GM. Positron emission tomography is superior to computed tomography for metastatic detection in melanoma patients. Ann Surg Oncol. 2002 Aug;9(7):664-53.
Brady MS, Akhurst T, Spanknebel K, Hilton S, Gonen M, Patel A, Larson S.
Utility of preoperative [(18)]f fluorodeoxyglucose-positron emission tomography scanning in high-risk melanoma patients.Ann Surg Oncol. 2006 Apr;13(4):525-32
http://tech.snmjournals.org/cgi/content/full/32/1/33/T3
Jeffrey D. Wagner Fluorodeoxyglucose Positron Emission Tomography for Melanoma Staging: Refining the Indications, Annals of Surgical Oncology 13:444-446 (2006)
AUMorton RL, Craig JC, Thompson The role of surveillance chest X-rays in the follow-up of high-risk melanoma patients. JFSOAnn Surg Oncol. 2009;16(3):571.
Recurrence/Restaging
A recommendation cannot be made for or against the use of PET for routine surveillance due to insufficient evidence.
Solitary Metastasis Identified at Time of Recurrence
PET is recommended for isolated metastases at time of recurrence or when contemplating metastasectomy.
2015 NCCN also incorporates PET/CT into its followup recommendations. For stages 0-IIA it recommends reimaging with CT or PET/CT only for specific signs or symptoms. For stage IIB-IV disease it recommends. “consider chest-X-ray, CT or PET/CT every 6-12 months to screen for recurrent or metastatic disease, for up to 5 years. Francken et al proposed a new follow-up schedule was proposed: stage I annually, stage IIA 6-monthly for 2 years and then annually, stage IIB-IIC 4-monthly for 2 years, 6-monthly in the third year and annually thereafter.
Morton RL, Craig JC, Thompson The role of surveillance chest X-rays in the follow-up of high-risk melanoma patients. Ann Surg Oncol. 2009;16(3):571.
Francken AB, Accortt NA, Shaw HM, Colman MH, Wiener M, Soong SJ, Hoekstra HJ, Thompson, Follow-up schedules after treatment for malignant melanoma. Br J Surg. 2008;95(11):1401
Petrella T, Walker-Dilks C. PET imaging in melanoma: recommendations. Toronto (ON): Cancer Care Ontario (CCO); 2009 Jan 19. 24 p. (Recommendation report – PET; no. 3). [19 references]
Vereecken P, Laporte M, Petein M, Steels E, Heenen M. Evaluation of extensive initial staging procedure in intermediate/high-risk melanoma patients.
J Eur Acad Dermatol Venereol. 2005 Jan;19(1):66-73.
T, Coleman JJ 3rd, Hutchins G, Love C, Wenck S, DaggyWagner JD, Schauwecker D, Davidson D, Logan Inefficacy of F-18 fluorodeoxy-D-glucose-positron emission tomography scans for initial evaluation in early-stage cutaneous melanoma.Cancer. 2005 Aug 1;104(3):570-9.
Swetter SM, Carroll LA, Johnson DL, Segall GM. Positron emission tomography is superior to computed tomography for metastatic detection in melanoma patients. Ann Surg Oncol. 2002 Aug;9(7):664-53.
Brady MS, Akhurst T, Spanknebel K, Hilton S, Gonen M, Patel A, Larson S.
Utility of preoperative [(18)]f fluorodeoxyglucose-positron emission tomography scanning in high-risk melanoma patients.Ann Surg Oncol. 2006 Apr;13(4):525-32
http://tech.snmjournals.org/cgi/content/full/32/1/33/T3
Jeffrey D. Wagner Fluorodeoxyglucose Positron Emission Tomography for Melanoma Staging: Refining the Indications, Annals of Surgical Oncology 13:444-446 (2006)
AUMorton RL, Craig JC, Thompson The role of surveillance chest X-rays in the follow-up of high-risk melanoma patients. JFSOAnn Surg Oncol. 2009;16(3):571.
Solitary Metastasis Identified at Time of Recurrence
PET is recommended for isolated metastases at time of recurrence or when contemplating metastasectomy.
2011 NCCN incorporates PET/CT into its followup recommendations. For stages 0-IIA it recommends reimaging with CT or PET/CT only for specific signs or symptoms. For stage IIB-IV disease it recommends. “consider chest-X-ray, CT or PET/CT every 6-12 months to screen for recurrent or metastatic disease, for up to 5 years. Francken et al proposed a new follow-up schedule was proposed: stage I annually, stage IIA 6-monthly for 2 years and then annually, stage IIB-IIC 4-monthly for 2 years, 6-monthly in the third year and annually thereafter.
Morton RL, Craig JC, Thompson The role of surveillance chest X-rays in the follow-up of high-risk melanoma patients. Ann Surg Oncol. 2009;16(3):571.
Francken AB, Accortt NA, Shaw HM, Colman MH, Wiener M, Soong SJ, Hoekstra HJ, Thompson, Follow-up schedules after treatment for malignant melanoma. Br J Surg. 2008;95(11):1401
Petrella T, Walker-Dilks C. PET imaging in melanoma: recommendations. Toronto (ON): Cancer Care Ontario (CCO); 2009 Jan 19. 24 p. (Recommendation report – PET; no. 3). [19 references]
Vereecken P, Laporte M, Petein M, Steels E, Heenen M. Evaluation of extensive initial staging procedure in intermediate/high-risk melanoma patients.
J Eur Acad Dermatol Venereol. 2005 Jan;19(1):66-73.
T, Coleman JJ 3rd, Hutchins G, Love C, Wenck S, DaggyWagner JD, Schauwecker D, Davidson D, Logan Inefficacy of F-18 fluorodeoxy-D-glucose-positron emission tomography scans for initial evaluation in early-stage cutaneous melanoma.Cancer. 2005 Aug 1;104(3):570-9.
NCCN Melanoma 2017
Shannon C. Trotter, DO,corresponding authora Novie Sroa, MD, Richard R. Winkelmann, DO, Thomas Olencki, DO, and Mark Bechtel, MDaA Global Review of Melanoma Follow-up Guidelines. J Clin Aesthet Dermatol. 2013 Sep; 6(9): 18–26.
Swetter SM, Carroll LA, Johnson DL, Segall GM. Positron emission tomography is superior to computed tomography for metastatic detection in melanoma patients. Ann Surg Oncol. 2002 Aug;9(7):664-53.
Brady MS, Akhurst T, Spanknebel K, Hilton S, Gonen M, Patel A, Larson S.
Utility of preoperative [(18)]f fluorodeoxyglucose-positron emission tomography scanning in high-risk melanoma patients.Ann Surg Oncol. 2006 Apr;13(4):525-32
http://tech.snmjournals.org/cgi/content/full/32/1/33/T3
Jeffrey D. Wagner Fluorodeoxyglucose Positron Emission Tomography for Melanoma Staging: Refining the Indications, Annals of Surgical Oncology 13:444-446 (2006)
AUMorton RL, Craig JC, Thompson The role of surveillance chest X-rays in the follow-up of high-risk melanoma patients. JFSOAnn Surg Oncol. 2009;16(3):571.
Revised:8/2/2011