47 year old male with bulky right axillary metastasis from the right arm primary melanoma (stage IIIC) was a candidate for a wide local excision and right axillary lymph node dissection.
A. Contrast enhanced CT shows large metastatic mass in the right axilla (arrow).
B. Preoperative PET-CT shows known primary melanoma of the right arm (arrow), known right axillary metastasis (long arrow), and multiple unexpected skeletal metastases (arrowheads). The surgery was cancelled.
C. Axial fused PET-CT image shows intense FDG uptake within T2 vertebra (arrow).
D. No obvious skeletal abnormality is seen on contrast enhanced CT.