Studies have suggested that early detection by sentinel node biopsy of sentinel lymph node metastasis is associated with a survival benefit when compared with a watch-and-wait approach in patients who develop clinical lymph node recurrence, Dr. Gershenwald noted.
With respect to the use of fluorodeoxyglucose positron-emission tomography (FDG-PET), which has been shown in several reports to be a more sensitive indicator of metastatic melanoma than conventional imaging, limitations in the study designs may overestimate the utility of this imaging modality for this indication, he said.
The literature supports the use of adjunctive PET imaging in properly selected patients with metastatic or recurrent melanoma, but it does not provide evidence suggesting that FDG-PET should be obtained in all melanoma patients, he reported.
Specifically, FDG-PET rarely identifies the presence of occult distant metastases in early stage melanoma patients who have been staged using sentinel node biopsy, whch means the likelihood is low that these patients will be upstaged based on the FDG-PET results.