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Immune-Related Erythema Nodosum Mimicking in Transit Melanoma Metastasis on [18F]-FDG PET/CT

1
Department of Nuclear Medicine, Institut Curie, 92210 Saint-Cloud, France
2
Laboratoire d’Imagerie Translationnelle en Oncologie, Inserm, Institut Curie, 91401 Orsay, France
3
Department of Dermatology, Hôpital Ambroise Paré, AP-HP, 92100 Boulogne-Billancourt, France
4
Department of Pathology, Hôpital Ambroise Paré, AP-HP, 92100 Boulogne-Billancourt, France
*
Author to whom correspondence should be addressed.
Academic Editors: Nicolas Aide, Laurent Dercle and Laetitia Vercellino
Diagnostics 2021, 11(5), 747; https://doi.org/10.3390/diagnostics11050747
Received: 18 March 2021 / Revised: 13 April 2021 / Accepted: 21 April 2021 / Published: 22 April 2021
(This article belongs to the Special Issue Imaging Diagnosis for Melanoma)
Early detection of immune-related adverse events (irAEs) with immune checkpoint inhibitors (ICIs) is crucial, particularly when these are likely to mimic tumor progression, as well as sarcoid-like reactions. Here, we report the case of a 68-year woman, with a history of four primary cutaneous melanomas (thickest lesion with BRAF mutation removed from the left axilla 2 years before), who was diagnosed with BRAF V600E-mutant metastatic melanoma and treated by ICI targeting the PD-1 receptor. Follow-up whole-body positron emission tomography/computed tomography (PET/CT) using 18F-fluorodeoxyglucose ([18F]-FDG) was performed at 15 months, and FDG-avid subcutaneous nodules on her legs were detected. A biopsy from a lesion on her right leg was obtained, and histology strongly suggested erythema nodosum. Given the isolated nature of these lesions, the normal serum Angiotensin-Converting Enzyme and the context of ICI, an immune-related sarcoid-like reaction was retained as the most likely diagnosis. Recent literature in immune-oncology suggests that erythema nodosum could be directly related to ICI(s). Although erythema nodosum is a rare occurrence with imaging features overlapping with malignancy, it should be considered in the differential diagnosis of suspicious in-transit metastasis, especially when the patient is treated with ICIs and when lesions follow a bilateral distribution. In conclusion, nuclear medicine physicians should keep in mind this irAE when interpreting PET/CT scans in clinical practice in order to avoid false-positive findings. View Full-Text
Keywords: [18F]-FDG PET/CT; metastatic melanoma; immune checkpoint inhibitor; erythema nodosum; sarcoid-like reaction; biopsy [18F]-FDG PET/CT; metastatic melanoma; immune checkpoint inhibitor; erythema nodosum; sarcoid-like reaction; biopsy
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MDPI and ACS Style

Seban, R.-D.; Vermersch, C.; Champion, L.; Bonsang, B.; Roger, A.; Ghidaglia, J. Immune-Related Erythema Nodosum Mimicking in Transit Melanoma Metastasis on [18F]-FDG PET/CT. Diagnostics 2021, 11, 747. https://doi.org/10.3390/diagnostics11050747

AMA Style

Seban R-D, Vermersch C, Champion L, Bonsang B, Roger A, Ghidaglia J. Immune-Related Erythema Nodosum Mimicking in Transit Melanoma Metastasis on [18F]-FDG PET/CT. Diagnostics. 2021; 11(5):747. https://doi.org/10.3390/diagnostics11050747

Chicago/Turabian Style

Seban, Romain-David, Camille Vermersch, Laurence Champion, Benjamin Bonsang, Anissa Roger, and Jerome Ghidaglia. 2021. "Immune-Related Erythema Nodosum Mimicking in Transit Melanoma Metastasis on [18F]-FDG PET/CT" Diagnostics 11, no. 5: 747. https://doi.org/10.3390/diagnostics11050747

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