Diagnosis and treatment of melanoma patients with lymph node metastases

PhD ceremony: Ms. E. Bastiaannet, 12.45 uur, Academiegebouw, Broerstraat 5, Groningen

Dissertation: Diagnosis and treatment of melanoma patients with lymph node metastases

Promotor(s): prof. H.J. Hoekstra, prof. O.S. Hoekstra, prof. E.J. van der Jagt

Faculty: Medical Sciences

The incidence of melanoma has doubled in the Netherlands in the last years. Accurate staging is extremely important to determine the appropriate treatment for melanoma patients. A total of 251 melanoma patients with palpable lymph node metastases were included in a Dutch, prospective study to assess the value of both PET and CT scan in the staging of these patients.The results showed that in 27% of the patients distant metastases could be detected with FDG-PET and in 24% of the patients with the CT scan; this difference was not statistically different (p=0.18). The FDG-PET scan, however, showed more metastases than the CT scan.

Both FDG-PET and CT scan are indicated for the staging of melanoma patients with lymph node metastases. Our cost-effectiveness analysis showed that adding only CT to the diagnostic work-up decreased costs with 5.5%, adding only FDG-PET increased costs with 7% and adding both modalities increased costs with 15%. Introduction of the new combined modality of FDG-PET and CT may reduce the costs for diagnosis and treatment per patient.

As a result of improved staging, 25% of the patients with lymph node metastases will be diagnosed with distant metastases. A large proportion of the patients may undergo surgical treatment of the lymph node metastases, in some patients this will be combined with chemotherapy or immunotherapy treatment.