Interesting Images18F-Fluciclovine–Avid Mediastinal Lymph Node Metastasis of Cutaneous Malignant MelanomaShariftabrizi, Ahmad MD∗; Pillenahalli Maheshwarappa, Ravishankar MD, MBBS†; Kahn, Daniel MD∗; Pollard, Janet MD‡Author Information From the ∗Iowa City Veterans Affairs Health Care System †University of Iowa Hospitals and Clinics ‡Department of Nuclear Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA. Received for publication May 18, 2020; revision accepted August 23, 2020. This is an off-label use of 18F-fluciclovine in a newly diagnosed prostate cancer. This radiotracer is US Food and Drug Administration approved for use in cases of biochemical recurrence of prostate cancer to detect any evidence of recurrent prostate cancer on imaging. Conflicts of interest and sources of funding: none declared. Correspondence to: Ahmad Shariftabrizi, MD, Division of Molecular Imaging and Therapy, University of Iowa Carver College of Medicine, and Iowa City Veterans Affairs Medical Center, Room 2W30, 601 Highway 6 West (05), Iowa City, IA 52246. E-mails: [email protected], [email protected]. Clinical Nuclear Medicine: February 2021 - Volume 46 - Issue 2 - p e97-e99 doi: 10.1097/RLU.0000000000003319 Buy Metrics Abstract A 63-year-old man with recent diagnosis of high-risk prostate adenocarcinoma was referred to our Nuclear Medicine Department for 18F-fluciclovine PET/CT to rule out metastasis in the setting of elevated serum prostate-specific antigen levels. The patient had previous history of nodular melanoma of the right cheek treated 6 years back with surgery and adjuvant radiation. Surveillance 18F-FDG PET/CT for melanoma 1 month back had revealed enlarged FDG-avid mediastinal para-aortic lymph nodes, which on endoscopic biopsy had revealed melanoma metastasis. On current fluciclovine PET/CT, the same enlarged para-aortic lymph nodes showed fluciclovine uptake, suggesting false-positive uptake. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.