Melanoma - 39 year old woman with a history of melanoma

HISTORY:
39 year old woman with a history of melanoma who underwent excision now with a left lower lobe mass referred for restaging PET•CT to evaluate recurrent metastatic melanoma to the lung.

IMAGING FINDINGS:
There are multiple focal abnormal areas of increased FDG uptake of an intense nature involving the soft tissues posterior and closely adjacent to the proximal right humerus, large mass in the right lower lung, and soft tissues of the lower left buttock adjacent to the muscle.

TREATMENT:
This patient had Clark level IV melanoma remotely and had been followed with yearly CT scanning. Unfortunately, she missed her '01 follow up scan. After developing pain in the chest wall, she had a CT scan that showed a new right lower lobe mass. A biopsy was performed and was positive for metastatic melanoma. She then was referred for combined PET•CT to re-stage her disease and to see if she may be a surgical candidate (if she had one lung metastasis). By CT, her disease was localized to the left lower lobe. However, as shown in the figure, she had two unsuspected lesions identified adjacent to the right humerus and in the left gluteal muscle, making her a non-surgical candidate.

DISCUSSION:
This case demonstrates the power of PET•CT to identify lesions that are either not visible on the CT portion of the exam or are very subtle lesions. Both of these lesions were missed prospectively on the CT portion of the exam. In retrospect, there is minimal enhancement of the left gluteal lesion, but this would be a very difficult diagnosis prospectively.

Unfortunately, given the multiple unsuspected metastases, she became a non-surgical candidate.

Data courtesy of Dr. Todd Blodgett, University of Pittsburgh Medical Center