Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Imaging studies in melanoma

Kevin Donohoe, MD
Section Editor
Michael B Atkins, MD
Deputy Editor
Michael E Ross, MD


Melanoma is an aggressive cutaneous neoplasm that may spread to involve virtually any organ of the body. Dissemination may occur by direct extension from the primary site, by lymphatic spread to regional lymph nodes, or hematogenously. Almost all patients who die from melanoma do so with disseminated disease involving multiple organs; lung and intracranial metastases are the most frequent cause of death.

Imaging studies play an essential role in the initial staging and subsequent management of patients with melanoma by evaluating the extent of disease, detecting clinically occult disease, and/or determining the response to treatment [1-3]. The imaging modalities useful in patients with melanoma are reviewed here.

Topics summarizing the application of information from imaging studies include:

(See "Staging work-up and surveillance after treatment of melanoma".)

(See "Evaluation and treatment of regional lymph nodes in melanoma".)

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: May 23, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Jiménez-Requena F, Delgado-Bolton RC, Fernández-Pérez C, et al. Meta-analysis of the performance of (18)F-FDG PET in cutaneous melanoma. Eur J Nucl Med Mol Imaging 2010; 37:284.
  2. Mohr P, Eggermont AM, Hauschild A, Buzaid A. Staging of cutaneous melanoma. Ann Oncol 2009; 20 Suppl 6:vi14.
  3. Ho Shon IA, Chung DK, Saw RP, Thompson JF. Imaging in cutaneous melanoma. Nucl Med Commun 2008; 29:847.
  4. Meyers MO, Yeh JJ, Frank J, et al. Method of detection of initial recurrence of stage II/III cutaneous melanoma: analysis of the utility of follow-up staging. Ann Surg Oncol 2009; 16:941.
  5. Paulsen SR, Huprich JE, Fletcher JG, et al. CT enterography as a diagnostic tool in evaluating small bowel disorders: review of clinical experience with over 700 cases. Radiographics 2006; 26:641.
  6. Cronin CG, Prakash P, Blake MA. Oral and IV contrast agents for the CT portion of PET/CT. AJR Am J Roentgenol 2010; 195:W5.
  7. Blake SP, Weisinger K, Atkins MB, Raptopoulos V. Liver metastases from melanoma: detection with multiphasic contrast-enhanced CT. Radiology 1999; 213:92.
  8. Premkumar A, Marincola F, Taubenberger J, et al. Metastatic melanoma: correlation of MRI characteristics and histopathology. J Magn Reson Imaging 1996; 6:190.
  9. Pfannenberg C, Aschoff P, Schanz S, et al. Prospective comparison of 18F-fluorodeoxyglucose positron emission tomography/computed tomography and whole-body magnetic resonance imaging in staging of advanced malignant melanoma. Eur J Cancer 2007; 43:557.
  10. Buchbender C, Heusner TA, Lauenstein TC, et al. Oncologic PET/MRI, part 2: bone tumors, soft-tissue tumors, melanoma, and lymphoma. J Nucl Med 2012; 53:1244.
  11. Jouvet JC, Thomas L, Thomson V, et al. Whole-body MRI with diffusion-weighted sequences compared with 18 FDG PET-CT, CT and superficial lymph node ultrasonography in the staging of advanced cutaneous melanoma: a prospective study. J Eur Acad Dermatol Venereol 2014; 28:176.
  12. Miles K, McQueen L, Ngai S, Law P. Evidence-based medicine and clinical fluorodeoxyglucose PET/MRI in oncology. Cancer Imaging 2015; 15:18.
  13. Gillies RJ, Robey I, Gatenby RA. Causes and consequences of increased glucose metabolism of cancers. J Nucl Med 2008; 49 Suppl 2:24S.
  14. Mottaghy FM, Sunderkötter C, Schubert R, et al. Direct comparison of [18F]FDG PET/CT with PET alone and with side-by-side PET and CT in patients with malignant melanoma. Eur J Nucl Med Mol Imaging 2007; 34:1355.
  15. Strobel K, Dummer R, Husarik DB, et al. High-risk melanoma: accuracy of FDG PET/CT with added CT morphologic information for detection of metastases. Radiology 2007; 244:566.
  16. Steinert HC, von Schulthess GK. Initial clinical experience using a new integrated in-line PET/CT system. Br J Radiol 2002; 75 Spec No:S36.
  17. Wong ANM, McArthur GA, Hofman MS, Hicks RJ. The Advantages and Challenges of Using FDG PET/CT for Response Assessment in Melanoma in the Era of Targeted Agents and Immunotherapy. Eur J Nucl Med Mol Imaging 2017; 44:67.
  18. Cho SY, Lipson EJ, Im HJ, et al. Prediction of Response to Immune Checkpoint Inhibitor Therapy Using Early Time-Point FDG-PET/CT Imaging in Patients with Advanced Melanoma. J Nucl Med 2017.
  19. Holder WD Jr, White RL Jr, Zuger JH, et al. Effectiveness of positron emission tomography for the detection of melanoma metastases. Ann Surg 1998; 227:764.
  20. Gritters LS, Francis IR, Zasadny KR, Wahl RL. Initial assessment of positron emission tomography using 2-fluorine-18-fluoro-2-deoxy-D-glucose in the imaging of malignant melanoma. J Nucl Med 1993; 34:1420.
  21. Paquet P, Hustinx R, Rigo P, Piérard GE. Malignant melanoma staging using whole-body positron emission tomography. Melanoma Res 1998; 8:59.
  22. Rinne D, Baum RP, Hör G, Kaufmann R. Primary staging and follow-up of high risk melanoma patients with whole-body 18F-fluorodeoxyglucose positron emission tomography: results of a prospective study of 100 patients. Cancer 1998; 82:1664.
  23. Steinert HC, Huch Böni RA, Buck A, et al. Malignant melanoma: staging with whole-body positron emission tomography and 2-[F-18]-fluoro-2-deoxy-D-glucose. Radiology 1995; 195:705.
  24. Swetter SM, Carroll LA, Johnson DL, Segall GM. Positron emission tomography is superior to computed tomography for metastatic detection in melanoma patients. Ann Surg Oncol 2002; 9:646.
  25. Tyler DS, Onaitis M, Kherani A, et al. Positron emission tomography scanning in malignant melanoma. Cancer 2000; 89:1019.
  26. Budman DR, Camacho E, Wittes RE. The current causes of death in patients with malignant melanoma. Eur J Cancer 1978; 14:327.
  27. Tsai KK, Pampaloni MH, Hope C, et al. Increased FDG avidity in lymphoid tissue associated with response to combined immune checkpoint blockade. J Immunother Cancer 2016; 4:58.
  28. Wachsmann JW, Ganti R, Peng F. Immune-mediated Disease in Ipilimumab Immunotherapy of Melanoma with FDG PET-CT. Acad Radiol 2017; 24:111.
  29. Elstrom RL, Leonard JP, Coleman M, Brown RK. Combined PET and low-dose, noncontrast CT scanning obviates the need for additional diagnostic contrast-enhanced CT scans in patients undergoing staging or restaging for lymphoma. Ann Oncol 2008; 19:1770.
  30. la Fougère C, Pfluger T, Schneider V, et al. Restaging of patients with lymphoma. Comparison of low dose CT (20 mAs) with contrast enhanced diagnostic CT in combined [18F]-FDG PET/CT. Nuklearmedizin 2008; 47:37.
  31. Gollub MJ, Hong R, Sarasohn DM, Akhurst T. Limitations of CT during PET/CT. J Nucl Med 2007; 48:1583.
  32. Brechtel K, Klein M, Vogel M, et al. Optimized contrast-enhanced CT protocols for diagnostic whole-body 18F-FDG PET/CT: technical aspects of single-phase versus multiphase CT imaging. J Nucl Med 2006; 47:470.
  33. Pfannenberg AC, Aschoff P, Brechtel K, et al. Value of contrast-enhanced multiphase CT in combined PET/CT protocols for oncological imaging. Br J Radiol 2007; 80:437.
  34. Stoffels I, Boy C, Pöppel T, et al. Association between sentinel lymph node excision with or without preoperative SPECT/CT and metastatic node detection and disease-free survival in melanoma. JAMA 2012; 308:1007.
  35. Vermeeren L, van der Ploeg IM, Olmos RA, et al. SPECT/CT for preoperative sentinel node localization. J Surg Oncol 2010; 101:184.
  36. Stoffels I, Müller M, Geisel MH, et al. Cost-effectiveness of preoperative SPECT/CT combined with lymphoscintigraphy vs. lymphoscintigraphy for sentinel lymph node excision in patients with cutaneous malignant melanoma. Eur J Nucl Med Mol Imaging 2014; 41:1723.
  37. Jimenez-Heffernan A, Ellmann A, Sado H, et al. Results of a Prospective Multicenter International Atomic Energy Agency Sentinel Node Trial on the Value of SPECT/CT Over Planar Imaging in Various Malignancies. J Nucl Med 2015; 56:1338.
  38. Remenschneider AK, Dilger AE, Wang Y, et al. The predictive value of single-photon emission computed tomography/computed tomography for sentinel lymph node localization in head and neck cutaneous malignancy. Laryngoscope 2015; 125:877.
  39. Brenner DJ. Medical imaging in the 21st century--getting the best bang for the rad. N Engl J Med 2010; 362:943.
  40. Patel JK, Didolkar MS, Pickren JW, Moore RH. Metastatic pattern of malignant melanoma. A study of 216 autopsy cases. Am J Surg 1978; 135:807.
  41. Wong SL, Balch CM, Hurley P, et al. Sentinel lymph node biopsy for melanoma: American Society of Clinical Oncology and Society of Surgical Oncology joint clinical practice guideline. J Clin Oncol 2012; 30:2912.
  42. Wong SL, Balch CM, Hurley P, et al. Sentinel lymph node biopsy for melanoma: American Society of Clinical Oncology and Society of Surgical Oncology joint clinical practice guideline. Ann Surg Oncol 2012; 19:3313.
  43. Acland KM, Healy C, Calonje E, et al. Comparison of positron emission tomography scanning and sentinel node biopsy in the detection of micrometastases of primary cutaneous malignant melanoma. J Clin Oncol 2001; 19:2674.
  44. Mijnhout GS, Hoekstra OS, van Lingen A, et al. How morphometric analysis of metastatic load predicts the (un)usefulness of PET scanning: the case of lymph node staging in melanoma. J Clin Pathol 2003; 56:283.
  45. Wagner JD, Schauwecker D, Davidson D, et al. Prospective study of fluorodeoxyglucose-positron emission tomography imaging of lymph node basins in melanoma patients undergoing sentinel node biopsy. J Clin Oncol 1999; 17:1508.
  46. Reynolds HM, Walker CG, Dunbar PR, et al. Functional anatomy of the lymphatics draining the skin: a detailed statistical analysis. J Anat 2010; 216:344.
  47. van der Ploeg IM, Kroon BB, Valdés Olmos RA, Nieweg OE. Evaluation of lymphatic drainage patterns to the groin and implications for the extent of groin dissection in melanoma patients. Ann Surg Oncol 2009; 16:2994.
  48. Uren RF, Howman-Giles RB, Shaw HM, et al. Lymphoscintigraphy in high-risk melanoma of the trunk: predicting draining node groups, defining lymphatic channels and locating the sentinel node. J Nucl Med 1993; 34:1435.
  49. Uren RF, Howman-Giles R, Thompson JF. Lymphatic drainage from the skin of the back to retroperitoneal and paravertebral lymph nodes in melanoma patients. Ann Surg Oncol 1998; 5:384.
  50. White DC, Schuler FR, Pruitt SK, et al. Timing of sentinel lymph node mapping after lymphoscintigraphy. Surgery 1999; 126:156.
  51. Ege GN. Internal mammary lymphoscintigraphy. The rationale, technique, interpretation and clinical application: a review based on 848 cases. Radiology 1976; 118:101.
  52. Gershenwald JE, Colome MI, Lee JE, et al. Patterns of recurrence following a negative sentinel lymph node biopsy in 243 patients with stage I or II melanoma. J Clin Oncol 1998; 16:2253.
  53. Gannon CJ, Rousseau DL Jr, Ross MI, et al. Accuracy of lymphatic mapping and sentinel lymph node biopsy after previous wide local excision in patients with primary melanoma. Cancer 2006; 107:2647.
  54. Voit C, Van Akkooi AC, Schäfer-Hesterberg G, et al. Ultrasound morphology criteria predict metastatic disease of the sentinel nodes in patients with melanoma. J Clin Oncol 2010; 28:847.
  55. Sanki A, Uren RF, Moncrieff M, et al. Targeted high-resolution ultrasound is not an effective substitute for sentinel lymph node biopsy in patients with primary cutaneous melanoma. J Clin Oncol 2009; 27:5614.
  56. Kostrubiak I, Whitley NO, Aisner J, et al. The use of computed body tomography in malignant melanoma. JAMA 1988; 259:2896.
  57. Fishman EK, Kuhlman JE, Schuchter LM, et al. CT of malignant melanoma in the chest, abdomen, and musculoskeletal system. Radiographics 1990; 10:603.
  58. Dalrymple-Hay MJ, Rome PD, Kennedy C, et al. Pulmonary metastatic melanoma -- the survival benefit associated with positron emission tomography scanning. Eur J Cardiothorac Surg 2002; 21:611.
  59. Orcurto V, Denys A, Voelter V, et al. (18)F-fluorodeoxyglucose positron emission tomography/computed tomography and magnetic resonance imaging in patients with liver metastases from uveal melanoma: results from a pilot study. Melanoma Res 2012; 22:63.
  60. Heiken JP, Weyman PJ, Lee JK, et al. Detection of focal hepatic masses: prospective evaluation with CT, delayed CT, CT during arterial portography, and MR imaging. Radiology 1989; 171:47.
  61. Nelson RC, Chezmar JL, Sugarbaker PH, Bernardino ME. Hepatic tumors: comparison of CT during arterial portography, delayed CT, and MR imaging for preoperative evaluation. Radiology 1989; 172:27.
  62. Ferrucci JT. Liver tumor imaging: current concepts. AJR Am J Roentgenol 1990; 155:473.
  63. Paley MR, Ros PR. Hepatic metastases: computed tomography versus magnetic resonance imaging in 1997. Endoscopy 1997; 29:524.
  64. Paley MR, Ros PR. Hepatic metastases. Radiol Clin North Am 1998; 36:349.
  65. Magnetic Resonance Imaging of CNS, Mosby Yearbook, Inc., 1995.
  66. Zukauskaite R, Schmidt H, Asmussen JT, et al. Asymptomatic brain metastases in patients with cutaneous metastatic malignant melanoma. Melanoma Res 2013; 23:21.
  67. Kurli M, Reddy S, Tena LB, et al. Whole body positron emission tomography/computed tomography staging of metastatic choroidal melanoma. Am J Ophthalmol 2005; 140:193.
  68. Aydin A, Yu JQ, Zhuang H, Alavi A. Detection of bone marrow metastases by FDG-PET and missed by bone scintigraphy in widespread melanoma. Clin Nucl Med 2005; 30:606.
  69. Daldrup-Link HE, Franzius C, Link TM, et al. Whole-body MR imaging for detection of bone metastases in children and young adults: comparison with skeletal scintigraphy and FDG PET. AJR Am J Roentgenol 2001; 177:229.
  70. Beiderwellen K, Huebner M, Heusch P, et al. Whole-body [¹⁸F]FDG PET/MRI vs. PET/CT in the assessment of bone lesions in oncological patients: initial results. Eur Radiol 2014; 24:2023.
  71. Mick CG, James T, Hill JD, et al. Molecular imaging in oncology: (18)F-sodium fluoride PET imaging of osseous metastatic disease. AJR Am J Roentgenol 2014; 203:263.
  72. Abikhzer G, Srour S, Fried G, et al. Prospective comparison of whole-body bone SPECT and sodium 18F-fluoride PET in the detection of bone metastases from breast cancer. Nucl Med Commun 2016; 37:1160.
  73. Fon GT, Wong WS, Gold RH, Kaiser LR. Skeletal metastases of melanoma: radiographic, scintigraphic, and clinical review. AJR Am J Roentgenol 1981; 137:103.
  74. Patten RM, Shuman WP, Teefey S. Metastases from malignant melanoma to the axial skeleton: a CT study of frequency and appearance. AJR Am J Roentgenol 1990; 155:109.
  75. Reintgen DS, Thompson W, Garbutt J, Seigler HF. Radiologic, endoscopic, and surgical considerations of melanoma metastatic to the gastrointestinal tract. Surgery 1984; 95:635.
  76. Branum GD, Seigler HF. Role of surgical intervention in the management of intestinal metastases from malignant melanoma. Am J Surg 1991; 162:428.
  77. Herlinger H, Maglinte D. Clinical Radiology of the Small Intestine, WB Saunders,, Philadelphia 1989.
  78. Tatlidil R, Mandelkern M. FDG-PET in the detection of gastrointestinal metastases in melanoma. Melanoma Res 2001; 11:297.
  79. Patten RM, Shuman WP, Teefey S. Subcutaneous metastases from malignant melanoma: prevalence and findings on CT. AJR Am J Roentgenol 1989; 152:1009.
  80. Mansour AA 3rd, Kelley MC, Hatmaker AR, et al. Verification of musculoskeletal FDG-PET-CT findings performed for melanoma staging. Ann Surg Oncol 2010; 17:1144.
  81. Savoia P, Fierro MT, Zaccagna A, Bernengo MG. Metastatic melanoma of the heart. J Surg Oncol 2000; 75:203.
  82. Kamel IR, Kruskal JB, Gramm HF. Imaging of abdominal manifestations of melanoma. Crit Rev Diagn Imaging 1998; 39:447.
  83. Merine D, Fishman EK, Jones B, Siegelman SS. Enteroenteric intussusception: CT findings in nine patients. AJR Am J Roentgenol 1987; 148:1129.
  84. Mittendorf EA, Lim SJ, Schacherer CW, et al. Melanoma adrenal metastasis: natural history and surgical management. Am J Surg 2008; 195:363.
  85. Shimkin PM, Soloway MS, Jaffe E. Metastatic melanoma of the gallbladder. Am J Roentgenol Radium Ther Nucl Med 1972; 116:393.