MELANOMA

Introduction
Demographics
Characteristics of metastases
Metastases to different systems
Melanoma
Malignant neoplasm of melanocytes
Most frequently arises from skin
Caucasian females, age 30-50, pigmented
lesion, often on leg
RF- sun exposure
Dx. biopsy
Depth of skin invasion at diagnosis
determines prognosis (Breslow, Clark)
Metastases
64% with disseminated disease develop
first metastasis within first year
Early melanoma can be successfully
treated buts mets have poor prognosis
Rx for mets include surgery,
chemotherapy, Dxt., immunotherapy
First mets to regional LN and skin

Radiological features
Typical of melanoma
Associated with melanin content
Hypervascularity
Tendency to cystic and haemorrhagic change
Hyperdense on CT
MRI- High on T1, low on T2
Non specific findings common to all
cancers
Central Nervous system
3
rd
most frequent cause of brain mets
Often cortico-medullary and multiple
CT- hyperdense (related to melanin),
surrounded by oedema. Haemorrhage
(19%), meningeal spread (11%)
MRI High signal on T1 low on T2
Spinal mets discrete or diffuse, intra or
extra medullary
CT brain mets
MRI pre/post gad
Pre and post gad T1 weighted MRI
Sphenoid met T1 MRI

Pre and post gad T1 MRI
Head and Neck
Most frequent intra-occular tumour in
adults
Variable size and shape, often associated
with retinal detachment
USS usually homogenously echogenic,
cystic change with necrosis / haemorrhage
Colour doppler tumour vascularity, low
resistance flow pattern,

Head and Neck
USS assess extra occular soft tissues
CT and MRI for extra scleral invasion
MRI High signal on T1 low on T2 (c.f vitreous)
for intra occular tumours
Scleral invasion thinning of dark scleral band,
increased scleral signal, contrast enhancement
Extra scleral invasion discontinuity of sclera,
soft tissue mass (different signal to fat)
Lymphadenopthy, bony mets, parotid glands
Choroidal melanoma and retinal detachment
Chest
Multiple pulmonary nodules on CXR
Less commonly solitary nodule,
lymphadenopathy and rarely miliary mets,
pleural effusion
Occasionally endobronchial and cardiac
mets (difficult to diagnose on imaging)
CT for staging
PET increases sensitivity
Mets
Miliary mets
Musculoskeletal
Bony mets in 23% of a series of 110
Most frequently spine
Majority osteolytic. Occasionally bony
expansion, subarticular location, sclerosis,
sclerotic rim
Pathological #s through mets are common
Bone scintigraphy more sensitive than
plain film
Musculoskeletal
Cutaneous and subcutaneous mets are
relatively common
CT-non specific soft tissue density nodules
USS- hypoechoic, smooth or lobulated
masses with distal acoustic enhancement,
with internal arterial flow
Skeletal muscle mets High on T1 low on
T2

Mets with pathological fracture
Abdominal wall metastasis
Left postero lateral abdo wall met

Right psoas met and subcutaneous
deposit

Breast
Melanoma 2
nd
most common primary to
spread to breast after breast primaries
Multiple well defined nodules, similar to
benign disease
Breast mets

Gastrointestinal
Relatively uncommon
Mostly small bowel, also stomach
Polypoid lesions (63% of GI mets from
melanoma in one series)
Cavitating mass (25%), infiltrative mass (16%),
target lesion (9%)
CT and SB follow through relatively inaccurate
(sensitivities 66 and 58 %)
Complicated by intussuseption, obstruction,
haemorrhage

Stomach met

Hepatobiliary
Most frequent site of visceral involvement
from melanoma
Hypervascular
Portal venous and unenhanced or arterial
phase scans
Typical MRI melanoma characteristics
(high T1) in 23%. More commonly low T1,
iso/high T2
USS hypoechoic lesion, fluid in 30%
Hepatobiliary
Gall bladder involvement in 15 % (post
mortem series)
Occasionally obstructive jaundice
Splenic mets in 35% at autopsy
Hepatic and splenic metastases
Biliary obstruction
Urogenital tract
3
rd
most frequent tumour to metastasize to
kidney (after lung and breast)
Renal parenchyma and perinephric fat
Adrenal mets (only lung camcer and renal
cell carcinoma are more frquent causes)
Reproductive organs occasionally involved
MRI useful in characterising adrenal mets
(chemical shift, in and opposed)
Adrenal and subcutaneous metastases
Renal metastasis
Conclusion
Malignant melanoma, once disseminated
is extremely aggressive
Typical radiological findings relate to
melanin content, hypervascularity, cystic
and haemorrhagic change
CT hyperdense, can be cystic,
haemorrhagic
MRI typically high on T1 low on T2
Atypical appearances, all systems affected