Metastatic melanoma detected by Tc-99m sestamibi during routine cardiac imaging

A 65-year-old man underwent routine stress Tc-99m sestamibi imaging for typical chest pain. Standard treadmill exercise with the Bruce protocol was performed and 30 mCi Tc-99m sestamibi was injected when the target heart rate was attained. Tomographic and planar images of the thorax obtained I hour later showed no significant cardiac perfusion abnormality, but multiple areas of increased tracer uptake were apparent in the anterior chest wall. Clinical evaluation revealed palpable masses in the anterior chest wall, and biopsy proved these to be metastatic melanoma.