56 Original article Routine positron emission tomography and positron emission tomography/computed tomography in melanoma staging with positive sentinel node biopsy is of limited benefit Anastasia Constantinidou a , Michael Hofman b , Michael O’Doherty b , Katharine M. Acland a , Ciaran Healy a and Mark Harries a Positron emission tomography (PET) is increasingly used for the staging and management of melanoma. The aim of this study was to evaluate the role of PET or PET/ computed tomography (CT) as a routine procedure in patients with positive sentinel node biopsy (SNB). Thirty patients with melanoma of Breslow thickness greater than 1 mm who had PET or PET/CT scans performed within 100 days after a positive SNB were reviewed retrospectively. Two patients (6%) had a positive PET scan, none of which were melanoma related. The first patient had a synchronous neuroendocrine thyroid tumour and the second patient had increased uptake in the chest wall, which proved to be old trauma. Lymph node dissection was positive in five cases (16%). With a median follow-up of 24 months, 21 patients remained disease free. In none of the 30 cases did the early PET scan after a positive SNB alter subsequent melanoma management. The role of PET scanning soon after a positive sentinel node biopsy seems to be of limited benefit. It is questionable whether any imaging is beneficial at this stage. The results of this review suggest that PET scanning might not be indicated for this group of patients. Melanoma Res 18:56–60  c 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins. Melanoma Research 2008, 18:56–60 Keywords: fluorodeoxyglucose, melanoma, melanoma staging, positive sentinel node biopsy, positron emission tomography a Melanoma Unit and b PET Imaging Centre, Guy’s and St Thomas’ Foundation NHS Trust, London, UK Correspondence to Anastasia Constantinidou, Suite 269, 210 Upper Richmond Road, SW15 6NP, London, UK Tel: + 447962348264; e-mail: a.constantinidou@yahoo.co.uk Received 24 September 2007 Accepted 22 December 2007 Introduction Melanoma of the skin has a rising incidence worldwide [1,2] and remains the most common cause among all skin cancer deaths. Prognosis and survival largely rely on early diagnosis and comprehensive staging, which have a major impact on therapeutic decision making. Primary surgical resection and where appropriate, sentinel node biopsy and selective dissection, is the mainstay of treatment with curative intent. In recent years, sentinel lymph node biopsy (SNB) has been established as the most powerful method for the staging of early melanoma. It is an accurate and safe procedure that identifies regional dissemination of the disease and determines the need for completion lympha- denectomy. SNB is widely accepted as one of the most significant prognostic factors [3,4] in melanoma; others include Breslow thickness, ulceration, level of invasion, tumour subtype, location in the body, sex and age. Imaging with whole-body fluorine 18-labeled deoxyglu- cose (FDG) – positron emission tomography (PET) is increasingly used for the staging and management of melanoma. It is a noninvasive method that has the ability to detect lesions as small as 3 mm. A significant number of studies have been conducted to determine the role of PET imaging in the management of different stages of the disease. PET seems to have limited sensitivity for regional staging in patients with AJCC stages I and II [5,6]. Sentinel node biopsy remains the standard of care for these patients maintaining much higher sensitivity in the detection of subclinical lymph node involvement [7–9]. PET has a high sensitivity and specificity in advanced melanoma (AJCC stages III and IV) for detection of distant metastases [10,11]. Furthermore, PET has been shown to be superior to both clinical examination and conventional imaging techniques such as radiographs, CT scans and MRI scans in identifying systemic melanoma [12,13]. More recently, PET/CT imaging has been developed, combining detection of metabolic (PET) and anatomic (CT) activity, thus achieving higher accuracy [14] than PET alone in the determination of metastatic sites. Limited information is available on the clinical utility of PET or PET/CT in assessing occult metastatic disease in melanoma patients with positive sentinel node biopsy before proceeding to completion lymphadenectomy. Lymph node dissection is the treatment of choice for localized disease, but it is an aggressive procedure with 0960-8931  c 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.