[.sup.18F]FDG PET/CT showed an FDG-avid linear, heterogeneously enhancing soft-tissue lesion of approximately 4.8 cm in length in the medial aspect of left thigh, anterior to the left sartorius muscle, suggesting in-transit metastasis (Figure 1).
Hence, he was referred for [.sup.18F]FDG PET/CT scan as a part of metastatic workup, which showed in-transit metastasis in addition to postoperative changes in left foot.
A primary BRAFF600E positive 0.9 mm Breslow thickness superficial spreading malignant melanoma was treated with wide local excision the previous year, which recurred within five months and he was found to have in-transit metastasis
with left axillary palpable lymphadenopathy.
Five patients underwent inguinal dissection after groin lymphadenopathy was noted on physical examination at the time of primary lower extremity melanoma diagnosis, 3 patients had positive SLNB, one patient had wide spread in-transit metastasis, and the other 12 patients underwent dissection for primary thick melanomas ([greater than or equal to]4 mm).
Only one patient (who had widespread in-transit metastasis at the first admission) developed pulmonary metastasis 6 months after the operation and he was lost during the follow up.
-- pN2c: Satellite or in-transit metastasis without nodal metastasis
-- pN3: Metastasis in 4 or more regional lymph nodes or matted metastatic nodes or in-transit metastasis or satellites(s) with metastasis in regional node(s)
Patients with stage II melanoma have clinical or radiologic evidence of regional lymph node metastasis (either in regional lymph nodes or intralymphatic metastasis, manifesting as either satellite or in-transit metastasis
* N2: Metastasis more than 3 cm in greatest dimension in any regional lymph node(s) and/or in-transit metastasis.
This staging is accomplished through evaluation of the local tumor site, adjacent skin (for in-transit metastasis), regional lymph nodes that drain the primary tumor site and distant organs that commonly are involved with metastatic melanoma (liver, lungs, bones, brain and viscera).