Role of PET/CT in the management of melanoma

The management of advanced melanoma has changed with the development of new targeted therapies. At each step of the disease, the dermatologist must address clinical issues where 18F-FDG PET/CT can be relevant. At initial staging, PET/CT is useful for assessing disease extension, especially in stage III and IV melanomas (with nodal or metastatic involvement). It allows the depiction of lesions, whether known (in order to make follow-up easier), or unknown. In case of proven or suspected recurrent disease, it can guide therapeutic strategy, by directing the patient to a local treatment in case of loco-regional disease, or a systemic treatment in case of metastatic disease. PET/CT may also have a part in therapeutic evaluation, even if it is still not fully codified. Indeed, the efficiency of innovative therapies can be difficult to assess with conventional imaging, which can prevent from quick changes of treatment. The ability of FDG PET/CT to detect lesions can be limited for small lesions, or in some localisations such as brain where the contrast between normal and pathologic tissue is low with this tracer. In the first case, the solution will come from the improvement of detection ability of PET/CT systems, and in the second case, the solution will arise from the development of radiopharmaceuticals specific of melanoma. (C) 2014 Elsevier Masson SAS. All rights reserved.