What Does My PET Scan Indicate?

Posted on Wed, 23 Apr 2014

Question: Hi I have been diagnosed with two invasice malignant melanomas breslow level II on my neck ( Left ) and large toe ( left ) undergone WLE which showed clear margins. A PET Scan showed intense activity around my left thyroid nodule and us show three complex nodles within the left throid lobe .6 x. 7 .7x.9 and 1.1 x 11.7 ( this has to be a typo as i do not feel a huge melon in my neck . The first showed increased vascularity. I am under an oncologist and obviously I see him but I feel I need to be my own advocate after a previoius dr saw nothing wrong with my neck mole. So i have two questions regarding reports. The first question is can you please explain the US in layman terms. If this is not malignant then I want to know what to do about 3 thyroid nodules as my oncologist will only be looking from a cancer perspective . Secondly and I may need to ask a pathologist about this please can you explain the pathology on my neck melanoma. I am interested in this very much . Especially with the possibility of a thyroid mass/met ?? Melanocyes are seen extending across most the of specimen in a confluent pattern. Melanocytes are also seen extending into the underlying dermis as single cells and nests. A stain confirms the unusual nature of this melamocytic proliferation. I think I understand what it is saying what I dont understand is the implication if at all of this and why is is unusual ? Can you please confirm

Answered by Dr. Krishna Kiran Kannepalli (6 hours later)

Brief Answer: The thyroid nodules need an FNAC. Detailed Answer: Hi. Thanks for the query. First let me answer the thyroid part. You said that there is activity around the thyroid nodule. By that I assume that the activity is from the thyroid nodule. Ultrasound shows 3 complex nodules and one of them has increased vascularity. These findings are significant as thyroid nodules that are hot on PET have 33% chance of being malignant. A needle cytology (FNAC) is required to ascertain the nature of the thyroid nodules. Regarding your question on melanoma, with the description that you have given, it is probably a superficial spreading type of melanoma. There are a few variants of melanoma. Superficial spreading, nodular, lentigo and amelanotic types. each melanoma has 2 growth phases. a horizontal growth phase during which it spreads over the skin and a vertical growth phase, during which it spreads during which it spreads vertically down into the deeper layers of the skin and beyond. A Breslow thickness of II indicates that the vertical depth is between 1 and 2 mm. some centers perform a sentinel lymph node biopsy to look at the nodal status. This is however not mandatory and you can discuss with your oncologist regarding this.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Krishna Kiran Kannepalli (1 hour later)

Thank you Should i be concerned at all with the close proximity of the neck melanoma and the possibility of a malignant thyroid mass ? I have a FNAC scheduled for Thursday. Should I ask for anything else to be done to rule out a met to this. If it comes back negative is it possible it could be a false negative ? Should I do anything in view of the hot pet scan and my neck melanoma ? What do you think the pathologist meant by unusual nature ? Thank you

Answered by Dr. Krishna Kiran Kannepalli (23 hours later)

Brief Answer: FNAC should give the answer. Detailed Answer: Hi. Thanks for the query. FNAC of the nodules is sufficient. It isthe gold standard test. It is preferable to go for an ultrasound guided FNA. I can't comment on the pathology report without actually looking at it.

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Above answer was peer-reviewed by : Dr. Shanthi.E