Editorial Current Radiopharmaceuticals, 2020, Vol. 13, No. 1 3 EDITORIAL Imaging in Melanoma Management: What's New Under the Sun? Pierpaolo Alongi 1,* , Giuseppe Argenziano 2 and Luigi Mansi 3,* 1 Nuclear Medicine Unit, Fondazione Istituto G.Giglio, Cefalù, Italy; 2 Dermatology Unit, University of Campania, Naples, Italy; 3 Section Health and Development, Interuniversity Research Center for Sustainability (CIRPS), Naples, Italy Melanoma is the most biologically aggressive tumor of the skin, responsible of the majority of deaths due to skin cancer [1]. In the last few decades, clinicians improved dramatically their ability to recognize melanoma in its early phase but, still, about 20% of the patients die due to disease progression [2-4]. In the context of advanced disease, the introduction of new target therapies and immunotherapy allowed a substantial im- provement of the prognosis of patients with metastases. Ten years ago, the average overall survival of stage 4 melanoma pa- tients was only 6 months. Today, the average overall survival reached 2 years, with several patients achieving the status of long-term survivors [5]. Due to these dramatic changes in life expectation of advanced melanoma patients, management protocols and follow-up procedures changed consequently. Before the era of target and immune-therapies, there was basically no need to perform ag- gressive imaging procedures to monitor disease-free patients. In other words, early diagnosis of disease recurrence was not suf- ficient to improve patient survival. In contrast, with the introduction of the new treatments of advanced disease, the early rec- ognition of metastatic disease became definitely important in order to start, as soon as possible, the proper treatment and to effi- ciently prolong survival. This is why imaging of disease-free patients became strictly relevant. In this hot topic issue on the developing role of nuclear medicine in melanoma, the value of diagnostic imaging is presented to individuate fields of actual application and perspectives. Being the main indications connected with staging and restaging, we will also discuss here the possible role in better defining diagnosis and prognostic stratification of the primary lesion, and in the early evaluation of therapeutic response. As reported above, melanoma is an aggressive tumour, historically with poor prognosis and high mortality, although recent advances in chemotherapy and immunotherapy regimes granted improved survival. At the first diagnosis, to define therapeutic strategies, the most important prognostic factors are the vertical growth of the tumour (pathologic Breslow index) and the invasion of the dermis. To acquire information on these issues, a contribution by diagnostic imaging may be given by Ultrasounds. In particular, as described by Reginelli et al. [6], High Frequency Ultrasono- graphy (HFUS) may allow a reliable in vivo evaluation of the superficial cutaneous layer, with a spatial resolution in the order of microns. The preliminary experience presented by the authors suggests the possibility that HFUS could be already included as support to traditional diagnostic methods in patients diagnosed with a nodular melanoma. In particular, HFUS may reliably determine the lateral margins and therefore the thickness of the lesion. Together with a prognostic stratification of the primary tumor, the preoperative evaluation of the presence of secondary le- sions is essential for establishing an optimal therapeutic approach and for improving the survival rate. Over primary tumor de- lineation, an accurate lymph-nodal staging, mainly based on a sentinel-node evaluation using nuclear medicine procedures, is mandatory. In their contribution, N. Quartuccio et al. [7] described the current clinical impact, also discussing the possible im- provement at staging associated either with SPECT/CT and using new emerging radiotracers, such as Tc99m-Tilmanocept. 18F-Fluorodeoxyglucose (FDG) PET/CT has been for many years suggested as a reliable and effective tool to complete the staging of patients affected by melanoma, with an advanced disease status. In their paper, R. Laudicella et al. [8] evaluated the increased contribution achievable using new PET/CT facilities and acquisition protocols. In particular, higher spatial resolution realizable with full digital PET/CT scanners, improving diagnostic accuracy either in the detection of lymph node and or distant metastases and a better definition of tumor relapse have been demonstrated. ____________________________________ *Address correspondence to these authors at the Nuclear Medicine Unit, Fondazione Istituto G. Giglio, Cefalù, Italy; Tel: 00390921920611; Fax:00390921920407; E-mail: alongi.pierpaolo@gmail.com *Section Health and Development, Interuniversity Research Center for Sustainability (CIRPS), Naples, Italy; Tel: 0039 3280024554; E-mail: mansi.luigi@libero.it 1874-4729/20 $65.00+.00 © 2020 Bentham Science Publishers