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