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Missing sentinel lymph node in cutaneous melanoma.

Luca Dellavedova¹, Luigia Florimonte², Marco Carletto³

¹Department of Nuclear Medicine, A. O. Ospedale Civile di Legnano, Legnano, Italy ; Nuclear Medicine Residency, University of Milan, Milano, Italy.

Indian Journal of Nuclear Medicine : IJNM : the Official Journal of the Society of Nuclear Medicine, India

|April 2, 2015

Summary

This summary is machine-generated.

Sentinel lymph node biopsy (SLNB) can be limited in thick melanoma cases. Combining SPECT/CT lymphoscintigraphy with 18F-FDG PET/CT improves regional staging accuracy for melanoma patients.

Keywords:

18F-fluorodeoxyglucose positron emission tomography/computed tomography cutaneous melanoma lymphoscintigraphy sentinel lymph node biopsy single-photon emission computed tomography/computed tomography

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Area of Science:

Oncology
Nuclear Medicine
Dermatology

Background:

American Society of Clinical Oncology guidelines recommend sentinel lymph node biopsy (SLNB) for intermediate-thickness melanoma (1-4 mm).
SLNB may also be considered for thick melanoma (>4 mm) for staging and regional control.
Accurate staging is crucial for effective melanoma treatment planning.

Observation:

A case report of an 82-year-old man with thick cutaneous melanoma of the right thigh is presented.
SPECT/CT lymphoscintigraphy failed to identify the true sentinel lymph node, showing uptake in an inguinal node.
A suspicious crural lymph node without radiotracer uptake was noted on CT.

Findings:

18F-FDG PET/CT revealed high metabolic activity in the suspicious crural lymph node.
Histopathology confirmed massive invasion in the crural node, identified as the true sentinel node.
The inguinal node showed no metastatic cells.

Implications:

This case highlights limitations of SLNB in thick melanoma.
SPECT/CT improves lymphoscintigraphy accuracy for sentinel lymph node identification.
18F-FDG PET/CT demonstrates utility in regional staging of melanoma, especially when SLNB is uncertain.