The role of selective sentinel lymphadenectomy is now firmly established as the best method for detecting occult regional melanoma metastases. Furthermore, for asymptomatic patients who have metastases to a sentinel lymph node (SLN), chest radiography; computed tomography of the brain, chest, abdomen, and pelvis; and magnetic resonance imaging of the brain have been shown to have a false-positive rate that well outweighs the true positive (0.5% vs 14%) at the time of selective sentinel lymphadenectomy.1 This discrepancy makes these techniques potentially more harmful than helpful in the initial workup of melanoma patients with regional metastases. In a study by Clark et al,2 none of the 19 patients with positive SLNs had metastases detected by positron emission tomography that could not have been found on routine physical examination. Consequently, it can be inferred that positron emission tomography is no different from other studied imaging methods in detecting occult distant metastases at the time of selective sentinel lymphadenectomy.
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