Peptide-targeted a-therapy with 7.4 MBq of 212 Pb-[1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid]-ReO-[Cys 3,4,10 , D-Phe 7 ,Arg 11 ]a-MSH 3-13 ( 212 Pb-DOTA-Re(Arg 11 )CCMSH) cured 45% of B16/F1 murine melanoma-bearing C57 mice in a 120-d study, highlighting its melanoma treatment potential. However, there is a need to develop an imaging surrogate for patientspecific dosimetry and to monitor the tumor response to 212 Pb-DOTA-Re(Arg 11 )CCMSH therapy. The purpose of this study was to evaluate the potential of 203 Pb-DOTA-Re(Arg 11 )CCMSH as a matched-pair SPECT agent for 212 Pb-DOTA-Re(Arg 11 ) CCMSH. Methods: DOTA-Re(Arg 11 )CCMSH was labeled with 203 Pb in 0.5 M NH 4 OAc buffer at pH 5.4. The internalization and efflux of 203 Pb-DOTA-Re(Arg 11 )CCMSH were determined in B16/F1 melanoma cells. The pharmacokinetics of 203 Pb-DOTARe(Arg 11 )CCMSH was examined in B16/F1 melanoma-bearing C57 mice. A micro-SPECT/CT study was performed with 203 Pb-DOTA-Re(Arg 11 )CCMSH in a B16/F1 melanoma-bearing C57 mouse at 2 h after injection. Results: 203 Pb-DOTARe(Arg 11 )CCMSH was easily prepared in NH 4 OAc buffer and completely separated from the excess nonradiolabeled peptide by reversed-phase high-performance liquid chromatography (RP-HPLC). 203 Pb-DOTA-Re(Arg 11 )CCMSH displayed fast internalization and extended retention in B16/F1 cells. Approximately 73% of 203 Pb-DOTA-Re(Arg 11 )CCMSH activity internalized after a 20-min incubation at 25°C. After incubation of the cells in culture medium for 20 min, 78% of internalized activity remained in the cells. 203 Pb-DOTA-Re(Arg 11 )CCMSH exhibited a biodistribution pattern similar to that of 212 Pb-DOTA-Re(Arg 11 )CCMSH in B16/ F1 melanoma-bearing mice. 203 Pb-DOTA-Re(Arg 11 )CCMSH exhibited a peak tumor uptake of 12.00 6 3.20 percentage injected dose per gram (%ID/g) at 1 h after injection. The tumor uptake gradually decreased to 3.43 6 1.12 %ID/g at 48 h after injection. 203 Pb-DOTA-Re(Arg 11 )CCMSH exhibited a peak tumor-to-kidney uptake ratio of 1.53 at 2 h after injection. The absorbed doses to the tumor and kidneys were 4.32 and 4.35 Gy, respectively, per 37 MBq. Whole-body clearance of 203 Pb-DOTA-Re(Arg 11 )CCMSH was fast, with approximately 89% of the injected activity cleared through the urinary system by 2 h after injection. 203 Pb showed 1.6-mm SPECT resolution, which was comparable to 99m Tc. Melanoma lesions were visualized through SPECT/CT images of 203 Pb-DOTA-Re(Arg 11 )CCMSH at 2 h after injection. Conclusion: 203 Pb-DOTA-Re(Arg 11 )CCMSH exhibited favorable pharmacokinetic and tumor imaging properties, highlighting its potential as a matched-pair SPECT agent for 212 Pb-DOTA-Re(Arg 11 )CCMSH melanoma treatment.