Many patients first learn that their melanoma has spread when, during a careful physical exam, their physician detects small metastases on the skin. Such tumors can then be located and removed by a surgeon.

But in other more difficult cases, tumors can develop deeper within fat beneath the skin, or even in muscles. These metastases can be found only by sensitive high-tech imaging methods such as PET/CT, an increasingly popular technique that combines positron emission tomography with standard x-ray computed tomography. Oncologic surgeons must plan carefully to find and remove these small tumors, which sometimes measure less than a quarter of an inch across.

Standard PET/CT scans still provide limited information in these complex cases, because the images can only be viewed in two-dimensional slices. A small multidisciplinary clinical team, all members of the NYU Interdisciplinary Melanoma Cooperative Group, has tackled the problem by developing a new method,called 3D PET/CT, to see these images in "real world" three-dimensional shapes. Team members Anna Pavlick, DO, Associate Professor of Medicine and Dermatology; Russell Berman, MD, Assistant Professor of Surgery; Richard Shapiro, MD, Associate Professor of Surgery; and Kent Friedman, MD, Assistant Professor of Radiology hope that the technique can help surgeons operate more safely and effectively.

"Depicting the juxtaposition of small melanoma metastases against muscle, bone, and blood vessels using three-dimensional techniques allows the surgeon to visualize the tumors as they will appear in real-life,” says Dr. Friedman. “This helps them to zoom in on the precise tumor locations when the patient is in the operating room."

While 3D imaging has previously been used to guide the removal of pancreatic and liver tumors, he adds, NYU Medical Center appears to be the first place where this innovative technique is being applied specifically to metastatic melanoma. The clinical team recently presented their method at the 2007 International Melanoma Congress Meeting held in New York.

Their research has already shown that 3D PET/CT allows the surgeon to more quickly and easily identify and remove small metastases in select patients. Further studies are needed to determine whether 3D PET/CT will translate into smaller, more focused surgical procedures, or possibly lead to higher success rates for removing more of the tumors identified in images prior to surgery. These improvements could potentially reduce the chance or recurrence and might also reduce the number of operations for individual patients,.

To answer these questions, Friedman and his team will soon be starting a prospective trial. They also plan to combine this 3D PET/CT work with the use of intraoperative probes designed to detect melanoma with either radioactive glucose or sestamibi, both nuclear medicine tracers.
Patients with metastatic melanoma who are considering surgery and would like to learn more about 3D PET/CT imaging, or are interested in participating in a clinical trial, may contact Dr. Pavlick. For more information, please call her office at the NYU Clinical Cancer Institute at (212) 731-5431.

The NYU Interdisciplinary Melanoma Cooperative Group (IMCG) is dedicated to advancing the care of melanoma patients through a coordinated approach that combines basic science, translational research, and clinical care. The IMCG, led by Iman Osman, MD, Associate Professor of Dermatology and Medicine (Oncology), is one of the largest and most well-established translation research programs in the United States. The clinical team manages over 2000 patients with melanoma each year. Its members belong to the departments/divisions of Surgical Oncology, Dermatology, Medical Oncology, Radiation Oncology, Nuclear Medicine, Dermatopathology, Anatomic Pathology, Immunology, and Genetics, as well as the Institute of Reconstructive Plastic Surgery, and Social and Psychology Services.