Imaging

Melanoma

Preliminary Diagnosis: Melanoma

I. What imaging technique is first-line for this diagnosis

  • Primary lesions are not commonly imaged.

II. Describe the advantages and disadvantages of this technique for diagnosis of melanoma.

  • Not applicable

III. What are the contraindications for the first-line imaging technique?

  • Not applicable

IV. What alternative imaging techniques are available?

  • CT with contrast

  • MRI with contrast

  • PET/CT

V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of melanoma.

CT with contrast

Advantages

  • Relatively inexpensive and fast imaging modality

  • Offers exquisite detail of the underlying osseous structures detailing osseous involvement from the primary tumor and helping detect bony metastasis

Disadvantages

  • Exposes patients to ionizing radiation

  • Less adept in staging the neoplastic process

MRI with contrast

Advantages

  • More sensitive and specific in detecting the extent of soft tissue invasion and infiltration of the primary tumor

  • Highly specific and sensitive in detecting perineural extent of tumor

  • Does not expose patients to ionizing radiation

  • More sensitive in detecting soft tissue metastasis compared to CT imaging

Disadvantages

  • Expensive

  • Time-consuming

  • Requires significant patient cooperation to minimize motion artifact

  • Less adept in staging the neoplastic process compared to companion PET/CT imaging

PET/CT

Advantages

  • More sensitive and specific in detecting the primary tumor and any soft tissue, osseous, or lymph node metastasis

  • High negative predictive value and may alter treatment

  • Gold standard in tumor staging

Disadvantages

  • Highly expensive imaging

  • Time-consuming

  • Requires significant patient cooperation

VI. What are the contraindications for the alternative imaging techniques?

CT with contrast

  • May be contraindicated in pregnant patients

  • Relative contraindication in patients with renal failure

  • Relative contraindication in patients with contrast allergy

MRI with contrast

  • Contraindicated in patients with non-MR compatible hardware

  • Gadolinium contrast is contraindicated in patients with a GFR less than or equal to 30

PET/CT

  • May be contraindicated in pregnant patients and patients who are breast-feeding

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