Surveillance for melanoma – pro

The role of PET in melanoma is not fully defined. Medicare currently covers PET for initial staging of melanoma and restaging, 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 (Petrella et al) 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.”  It also says that a recommendation cannot be made for or against the use of PET for routine surveillance due to insufficient evidence.

2012 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 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 (2008)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, ThompsonFollow-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]

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

Jeffrey D. Wagner Fluorodeoxyglucose Positron Emission Tomography for Melanoma Staging: Refining the Indications, Annals of Surgical Oncology 13:444-446 (2006)

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