Diagnostic value of 18 F-fluoro-2-deoxyglucose positron emission tomography/computed tomography imaging in acral melanoma– predominant Asian patients

Sep 29, 2026

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Background: Tumor staging is crucial for melanoma, and acral melanoma is predominant in Asian patients. 18F-fluoro-2-deoxyglucose (FDG) PET and FDG-PET/CT are noninvasive imaging tools for staging, yet evidence on PET diagnostic value for acral melanoma remains limited. Methods: January 1, 2006 to November 30, 2022, 352 melanoma patients; 90 cutaneous cases underwent preoperative PET/CT and sentinel lymph node biopsy or dissection, with PET/CT staging validated by histopathology or imaging follow-up.

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J Chin MedAssoc Original article Diagnostic value of 18 F-fluoro-2-deoxyglucose positron emission tomography/computed tomography imaging in acral melanoma– predominant Asian patients Kuan-Cheng Chena, Po-Yu Chua, Cheng-Yuan Lib,c, Tien-Hsiang Wanga,d, Yu-Jen Chiua,d,e,* aDivision of Plastic and Reconstructive Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; bDepartment of Dermatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; cInstitute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC; dDepartment of Surgery, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC; eInstitute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC Abstract Background: Tumor staging is crucial for melanoma, of which acral melanoma is the predominant subtype in Asians. 18F-fluoro- 2-deoxyglucose (FDG) positron emission tomography (PET) and 18F-FDG-PET/computed tomography (18F-FDG-PET/CT) serve as noninvasive imaging tools for tumor staging. However, the literature is scarce on the diagnostic value of PET for acral melanoma. Methods: From January 1, 2006 to November 30, 2022, a total of 352 patients were diagnosed with melanoma at our hospital. Of them, 90 were diagnosed with cutaneous melanoma and underwent preoperative PET/CT for staging and sentinel lymph node biopsy or complete lymph node dissection. Staging of PET/CT was confirmed by histopathology or following imaging. The lymph node biopsy, distant metastasis status, and PET/CT imaging results were analyzed. Results: Of all the 90 patients with cutaneous melanoma, 72 of them were diagnosed as acral melanoma (80 .0%) . Compared with the histopathologic results, the lymph nodes were true-positive, true-negative, false-positive, and false-negative in 12, 54, 7, and 17 cases, respectively. The sensitivity of PET/CT for local lymph nodes was 41.4%(95% CI, 23.5%-61 . 1%), whereas its specificity was 88.5%(95% CI, 77.8%-95 .3%) . As for the detection of distal metastasis, the PET results were true-positive, true-negative, false-positive, and false-negative in 6, 65, 15, and 4 cases, respectively. The sensitivity of PET for distal metastasis detection was 60.0%(95% CI, 26.2%-87 .8%), whereas its specificity was 81.3%(95% CI, 71.0%-89 . 1%) . Conclusion: Although noninvasive, PET/CT has relatively low sensitivity in regional lymph node evaluations, and fair sensitivity in distal metastasis detection in Asian patients with acral melanoma. Thus, PET/CT may be more useful in patients with clinically palpable nodes or more advanced disease stages. Keywords: Melanoma; Neoplasm Staging; Positron emission tomography; sentinel lymph node biopsy; sentinel lymph node 1. INTRODUCTION Melanoma is among the deadliest skin cancer, and its incidence is increasing worldwide with racial differences.1 Its incidence in Caucasians is 21.9 to 55.9 per 100 000 patient-years in Western countries vs only 0.2 to 0.5 per 100 000 patient-years in Asian countries.1 The staging of melanoma is crucial because different stages require different treatments and feature different prognoses.2 Surgical excision with adequate margins is the primary curative treatment for localized melanoma. If malignant cells * Address correspondence. Dr. Yu-Jen Chiu, Division of Plastic and Reconstructive Surgery, Department of Surgery, Taipei Veterans General Hospital, 201, Section 2, Shi-Pai Road, Taipei 112, Taiwan, [ROC. E-mail address: chiou70202@gmail.com](ROC. E-mail address: chiou70202@gmail.com) (Y.-J. Chiu). Conflicts of interest: The authors declare that they have no conflicts of interest related to the subject matter or materials discussed in this article. Journal of Chinese Medical Association. (2023) 86: 975-980. Received July 6, 2023; accepted August 29, 2023. doi: 10. 1097/JCMA.0000000000001002 Copyright © 2023, the Chinese Medical Association. This is an open acc

FAQs

What imaging methods were evaluated in acral melanoma patients?

The study assessed 18F-fluoro-2-deoxyglucose (FDG) PET and 18F-FDG-PET/computed tomography (18F-FDG-PET/CT) as noninvasive tools for tumor staging.

How were PET/CT staging results validated?

Lymph node biopsy results and distant metastasis status were analyzed, and PET/CT staging was confirmed by histopathology or by subsequent imaging follow-up.

What were the reported sensitivity and specificity for detecting local lymph node involvement?

For local lymph nodes, PET/CT sensitivity was 41.4% (95% CI, 23.5%-61.1%) and specificity was 88.5% (95% CI, 77.8%-95.3%).

What does the conclusion suggest about when PET/CT may be more useful?

Despite relatively low sensitivity for regional lymph nodes, PET/CT showed fair sensitivity for distal metastasis, suggesting it may be more useful in patients with clinically palpable nodes or more advanced disease stages.

Sep 29, 2026

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