Detection of bone marrow metastases by FDG-PET and missed by bone scintigraphy in widespread melanoma

The optimal management of patients with melanoma requires accurate imaging techniques that can screen the entire body for metastases. One of the most used tests for this purpose is bone scintigraphy. PET has been reported to be more sensitive than bone scintigraphy in some malignancies. In our case, FDG-PET was also superior to bone scintigraphy in detecting the extent of skeletal disease in a patient with melanoma. This is likely the result of the fact that metastasis to bone marrow may not result in bone reaction in certain conditions and therefore bone scans may remain negative despite skeletal involvement.