Melanoma - 53-year-old male with a history of melanoma returns for re-evaluation

History
53-year-old male with a history of melanoma returns for re-evaluation. He had a stage 1 melanoma that measured 3.4 millimeters in the right thigh. He underwent a wide excision with no residual tumor and his sentinel node study was negative. The patient received no radiation or chemotherapy. He has continued to do well and is now over 2 years disease free. Patient’s white count was 3.6, Hematocrit was 44, platelet count was 206,000. A chest x-ray shows a right lower lobe nodule. A CT scan was ordered to further evaluate the single nodule in the right lung field.

CT Findings
There is a calcified granuloma in the left upper lobe. There is an 11 mm nodule on the anterior aspect of the right middle lobe. Upper abdomen shows a 2.5 cm metastasis in the upper aspect of the right lobe of the liver with a small adjacent 8 mm lesion.

PET Findings
No abnormal brain uptake is present. The neck uptake is normal. In the chest, there are multiple areas of abnormal uptake consistent with malignancy. Both right middle lobe and right lower lobe lung nodule are highly metabolic consistent with melanoma metastatic disease. In addition, there is abnormal right hilar uptake as well as right paratracheal lymph node uptake consistent with additional metastatic disease. Lungs are clear. There are at least four foci of metastatic disease in the liver, largest in the dome measuring about 2-3 cm. The remaining abdomen is unremarkable.

Dosage
14.8 mCi FDG

Imaging
CTI REVEAL XL

Courtesy of
Thompson Cancer Survival Center