Perineural Spread of Melanoma Demonstrated by F-18 FDG PET With MRI and Pathologic Correlation

Lee, Theodore J.; Glastonbury, Christine M.; Buckley, Anne F.; Eisele, David W.; Hawkins, Randall A.

doi:10.1097/rlu.0b013e31815ef7be

Cited by 19 publications

(11 citation statements)

References 18 publications

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“…Perineural tumor spread is a well‐documented mechanism of metastasis in all head and neck malignancies. Melanoma demonstrating neurotropism typically arises from a primary on the head and neck region with desmoplastic histology and is associated with increased local recurrence and decreased disease‐free survival . Cranial nerves (trigeminal and facial) are most commonly affected, although nerve invasion of the brachial plexus has been reported as well …”

Section: Melanoma‐related Neurologic Complicationsmentioning

confidence: 99%

“…In asymptomatic cases, the diagnosis is often made by pathologic examination after surgery or on the basis of radiologic findings in more advanced cases. Imaging demonstrates destruction of fat planes around cranial nerve exit points and along the nerve routes . Magnetic resonance imaging (MRI) is the imaging method of choice for detecting perineural invasion because it allows for the entire course of the involved cranial nerve to be evaluated.…”

Section: Melanoma‐related Neurologic Complicationsmentioning

confidence: 99%

See 1 more Smart Citation

Neurologic complications of melanoma

Cohen

Wang

Venur

et al. 2019

Cancer

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Neurologic complications are common in patients with melanoma and are often associated with a poor prognosis. In an era with new, effective treatments, patients are living longer, and this has resulted in an increase in complications of both the disease and the therapy. A multidisciplinary approach to neurologic complications in patients with melanoma, with involvement from medical oncology, neurooncology, radiation oncology, and often neurosurgery, is necessary. In this review, neurologic complications of melanoma, including clinical implications and treatment strategies, are described. Cancer 2020;126:477-486.

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Section: Melanoma‐related Neurologic Complicationsmentioning

confidence: 99%

Section: Melanoma‐related Neurologic Complicationsmentioning

confidence: 99%

Neurologic complications of melanoma

Cohen

Wang

Venur

et al. 2019

Cancer

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“…10,11 Increased avidity with FDG PET has been described in perineural spread of melanoma, but the utility of PET/CT remains unknown. 16 Currently, MRI and PET/CT are used to complement each other in the imaging evaluation of perineural spread of malignancy.…”

Section: Postoperative Coursementioning

confidence: 99%

“…This mechanism of tumor spread for metastatic melanoma is well known to occur along the cranial nerves and cervical plexus. 4,9,14,[16][17][18] We describe a rare example of documented perineural spread of melanoma, arising in the mandible and extending along a cranial nerve, the cervical plexus, and into the brachial plexus. We correlate the clinicoradiological features and propose an anatomopathological explanation to support the mechanism of perineural spread in this case.…”

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confidence: 99%

Perineural spread of malignant melanoma from the mandible to the brachial plexus: case report

Restrepo¹,

Spinner²,

Howe

et al. 2015

JNS

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P erineural spread is increasingly recognized as a relatively common mechanism of metastasis in many types of malignancies, particularly those involving the head and neck region. This mechanism of tumor spread for metastatic melanoma is well known to occur along the cranial nerves and cervical plexus. 4,9,14,[16][17][18] We describe a rare example of documented perineural spread of melanoma, arising in the mandible and extending along a cranial nerve, the cervical plexus, and into the brachial plexus. We correlate the clinicoradiological features and propose an anatomopathological explanation to support the mechanism of perineural spread in this case. case report HistoryA 48-year-old right-handed woman presented in 2010 with a several-month history of progressive numbness, tingling, itching, and atrophy affecting the skin and muscles of the right neck. MRI of the cervical spine revealed right C2-3 and C3-4 foraminal masses (Fig. 1 left). The patient underwent observation. Repeat MRI performed 7 months later showed spinal cord displacement at the level of C-2 ( Fig. 1 right). The patient underwent an open biopsy-the findings of which were consistent with a neurofibromaand 1 week later, C2-4 laminectomy, decompression, and fusion. The lesion was partially resected. Postoperatively, the patient received 45-Gy radiotherapy to a field from the top of C-2 to the bottom of C-6, including the spinal cord as well as an 18-Gy boost to the right-sided upper cervical roots and nerves. Brain MRI findings at that time were normal. The brachial plexus was not imaged.Over the next 2 years the patient had persistent cervical discomfort and progressive pain in her right shoulder and then the biceps region. Neither partial removal of the instrumentation nor steroid injections provided relief of her pain, which progressed as time passed. In 2013 she was evaluated at a tertiary care facility when she noted weakness in shoulder abduction and external rotation. Imaging now revealed plexiform lesions involving multiple cervical nerves and the upper brachial plexus. Pathological specimens were reviewed and the findings were interpreted as hybrid schwannoma/neurofibroma. The patient was thought to have a segmental form of schwannomatosis.The patient had a history of melanoma. In 2001, she had a lesion excised from her trunk with no local recurrence. In 2004, she had a nearly 2-cm lesion excised from the angle of the right jaw, a fusion of lentigo maligna and desmoplastic types. It was invasive to Clark's Level IV 5 and Breslow's 3 depth 3 mm.The mitotic rate was 0. Local perineural invasion was evident in the specimen. Tumor was present at the biopsy margins. The BRAF was wild type. Findings from the sentinel cervical lymph node biopsy were negative. Physical ExaminationIn February 2014, the patient presented to our institution. Physical examination revealed atrophic right neck Perineural spread is a well-known mechanism of dissemination of head and neck malignancies. There are few reports of melanoma involving the brachial plexus in th...

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“…As Paes et al point out, perineural spread has prognostic and treatment implications, so its diagnosis can be important. Although perineural spread is not rare in head and neck malignancies and even occurs somewhat frequently with certain histologic types, the number of reports of its detection with FDG PET/CT is few, and the sensitivity and specificity of this modality are unknown (7)(8)(9)(10)(11)(12). The sensitivity would be expected to be low, however, given the relatively poor sensitivity of FDG PET/CT in the detection of lowvolume tumors.…”

Section: Invited Commentarymentioning

confidence: 99%