PET/CT variants and pitfalls in malignant melanoma

Area of Science:

• Nuclear Medicine
• Oncology
• Radiology

Background:

• 18F-FDG PET/CT is crucial for staging and monitoring high-risk melanoma.
• Novel therapies like tyrosine kinase inhibitors (TKI) and immune checkpoint inhibitors (ICIs) complicate response assessment.
• Technological advancements enhance detection of small lesions but introduce new interpretation challenges.

Purpose of the Study:

• To provide guidance on PET/CT protocols for melanoma imaging.
• To discuss interpretation pitfalls related to melanoma treatment and non-malignant conditions.
• To address challenges posed by new PET technologies and recent clinical contexts like COVID-19.

Main Methods:

• Review of current literature and clinical practice guidelines for melanoma PET/CT.
• Analysis of common and emerging pitfalls in interpreting PET/CT scans.
• Inclusion of case examples illustrating diagnostic challenges.

Main Results:

• New therapies and technologies necessitate updated interpretation strategies for melanoma PET/CT.
• Non-malignant findings and treatment-related changes (e.g., immune activation) can mimic malignancy.
• Advanced PET technology improves lesion detection but requires careful evaluation to avoid false positives.

Conclusions:

• Optimized PET/CT protocols and awareness of potential pitfalls are essential for accurate melanoma management.
• Understanding treatment effects, immune-related adverse events, and technological limitations is critical.
• Continuous education is needed to navigate evolving diagnostic landscapes in melanoma imaging.