Fig. 1

A 37-year-old woman, diagnosed with MM 8 years previously and a prior right groin recurrence 2 years later, was found to have a solitary right 1.5-cm iliac pedicle lymph node on a surveillance CT. A subsequent FDG PET-CT revealed several sites of markedly FDG-avid disease on the PET maximum intensity projection (a) and corresponding axial unenhanced CT and fused PET-CT images including the known enlarged right iliac pedicle lymph node (b), a 5-mm aorto-caval lymph node (c), a 4-mm retroperitoneal nodule overlying the right iliacus muscle (d) and a solitary right femoral bone metastasis inconspicuous on CT (e). This resulted in a change from potential radical surgery to chemotherapy—a major clinical impact