PET/CT to optimize treatment management of high-risk stage III and IV melanoma

Hiel, B. van der (2025)

Doctoral Thesis

Melanoma is an aggressive form of skin cancer that can spread rapidly throughout the body. PET/CT imaging plays an important role in detecting and monitoring this disease. This thesis investigated how PET/CT can be used to optimize treatment strategies for patients with stage III and IV melanoma. Most studies used the commonly applied tracer [18F]FDG, which visualizes glucose metabolism, while a smaller exploratory study focused on [18F]FLT, a tracer that reflects cell proliferation. 

This research shows that [18F]FDG PET/CT is highly effective in detecting recurrent melanoma early, both after surgery and during treatment. This allows physicians to adjust therapy sooner and to treat new metastases before symptoms occur. In addition, early metabolic changes on PET/CT scans during targeted therapy with BRAF/MEK inhibitors were associated with disease outcome, suggesting that PET/CT can help identify which treatments are most effective for each patient.

Although PET/CT cannot yet predict all treatment responses, it contributes significantly to more personalized and efficient care for patients with advanced melanoma. This knowledge helps to avoid unnecessary therapies and improve treatment selection.

• Melanoma
• PET/CT
• Recurrence
• [18F]FDG
• [18F]FLT
• BRAF/MEK
• Targeted therapy
• Response monitoring
• Resistance prediction

• All authors: Hiel, B. van der
• Supervisor: Haanen, J.B.A.G.; Eertwegh, A.J.M. van den
• Co-supervisor: Stokkel, M.P.M.
• Committee: Wouters, M.W.J.M; Bennink, R.J.; Kapiteijn, H.W.; Verkooijen, H.M.; Brouwers, A.H.
• Qualification: Doctor (dr.)
• Awarding Institution: Faculty of Medicine, Leiden University Medical Center (LUMC), Leiden University
• Date: 2025-12-09
• ISBN (print): 9789465224718