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Sonography of the Primary Cutaneous Melanoma: A Review

DOI: 10.1155/2012/814396

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The diagnosis and management of primary cutaneous melanoma have traditionally relied on clinical and histological characteristics. Nevertheless, in recent years there has been a significant growth in the usage of ultrasound for studying the cutaneous layers. Thus, the present paper focuses on the primary lesion, its sonographic characteristics, the potential benefits of early imaging, and the new developments on the ultrasound field applied to cutaneous melanoma. 1. Introduction Cutaneous malignant melanoma constitutes 4 to 11% of all skin cancers but is responsible for more than 75% of skin cancer-related deaths producing more than 8000 deaths per year in the United States [1]. To date the diagnosis is clinical, and the usage of ultrasound in the study of cutaneous melanoma has been focused more on the locoregional staging than on the primary lesion, and the prognosis being mainly assessed by clinical and histological features. The staging of melanoma is mostly based on the Breslow classification that relies on sequential tumor infiltration (depth) by histology within the different cutaneous layers, providing a measurement of the microscopic invasion from the stratum granulosum of the epidermis to the deepest portion of the tumor [2]. The Breslow index has been reported to correlate well with the prognosis of the disease. Moreover, according to the thickness of the primary tumor, important decisions are taken such as the size of the excision and the free margins or the requirement for a sentinel lymph node procedure. Nevertheless, there are controversial reports about the appropriate size of the excision that should be performed on melanoma. Hence, a small (but potentially important) difference in overall survival between wide and narrow excision margins has been reported that cannot be confidently ruled out. Literature has mentioned that recurrence-free survival is favored with wide excision (Hazard Ratio 1.13; ; 95% confidence interval 0.99 to 1.28) but the results have not reached statistical significance ( level). Furthermore, randomized trial evidence seems to be insufficient to address optimal excision margins for primary cutaneous melanoma [3]. Reports on recurrence rates in melanoma have shown a wide range depending on the stage of the primary tumor; thus, they can vary from 7.1% in stage I to 51% in stage III [4]. Moreover, older patients with thicker tumors and angiolymphatic invasion appear to be at higher risk for local and in-transit recurrence [5]. Hence, the appearance of in-transit metastasis seems to be linked to the biological


[1]  D. U. Ekwueme, G. Guy, C. Li, S. H. Rim, P. Parelkar, and S. C. Chen, “The health burden and economic costs of cutaneous melanoma mortality by race/ethnicity-United States, 2000 to 2006,” Journal of the American Academy of Dermatology, vol. 65, supplement 1, no. 5, pp. S133–S143, 2011.
[2]  D. T. Netscher, M. Leong, I. Orengo, D. Yang, C. Berg, and B. Krishnan, “Cutaneous malignancies: melanoma and nonmelanoma types,” Plastic and Reconstructive Surgery, vol. 127, no. 3, pp. 37e–56e, 2011.
[3]  M. J. Sladden, C. Balch, D. A. Barzilai et al., “Surgical excision margins for primary cutaneous melanoma,” Cochrane Database of Systematic Reviews, no. 4, p. CD004835, 2009.
[4]  U. Leiter, P. G. Buettner, T. K. Eigentler, et al., “Hazard rates for recurrent and secondary cutaneous melanoma: an analysis of 33,384 patients in the German Central Malignant Melanoma Registry,” Journal of the American Academy of Dermatology, vol. 66, no. 1, pp. 37–45, 2012.
[5]  C. C. Stucky, R. J. Gray, A. C. Dueck et al., “Risk factors associated with local and in-transit recurrence of cutaneous melanoma,” American Journal of Surgery, vol. 200, no. 6, pp. 770–774, 2010.
[6]  A. Clemente-Ruiz de Almiron and S. Serrano-Ortega, “Risk factors for in-transit metastasis in patients with cutaneous melanoma,” Actas Dermosifiliogr. In press.
[7]  X. Wortsman and J. Wortsman, “Clinical usefulness of variable-frequency ultrasound in localized lesions of the skin,” Journal of the American Academy of Dermatology, vol. 62, no. 2, pp. 247–256, 2010.
[8]  R. Badea, M. Cri?an, M. Lup?or, and L. Fodor, “Diagnosis and characterization of cutaneous tumors using combined ultrasonographic procedures (conventional and high resolution ultrasonography),” Medical Ultrasonography, vol. 12, no. 4, pp. 317–322, 2010.
[9]  O. Catalano, C. Caracò, N. Mozzillo, and A. Siani, “Locoregional spread of cutaneous melanoma: sonography findings,” American Journal of Roentgenology, vol. 194, no. 3, pp. 735–745, 2010.
[10]  J. Tacke, G. Haagen, O. Hornstein et al., “Clinical relevance of sonometry-derived tumour thickness in malignant melanoma—a statistical analysis,” British Journal of Dermatology, vol. 132, no. 2, pp. 209–214, 1995.
[11]  B. D. Fornage, M. H. McGavran, M. Duvic, and C. A. Waldron, “Imaging of the skin with 20-MHz US,” Radiology, vol. 189, no. 1, pp. 69–76, 1993.
[12]  P. Guitera, L. X. Li, K. Crotty et al., “Melanoma histological Breslow thickness predicted by 75-MHz ultrasonography,” British Journal of Dermatology, vol. 159, no. 2, pp. 364–369, 2008.
[13]  R. Vilana, S. Puig, M. Sanchez et al., “Preoperative assessment of cutaneous melanoma thickness using 10-MHz sonography,” American Journal of Roentgenology, vol. 193, no. 3, pp. 639–643, 2009.
[14]  M. M. Mu?i?, K. Hertl, M. Kadivec, M. D. Pavlovi?, and M. Ho?evar, “Pre-operative ultrasound with a 12-15 MHz linear probe reliably differentiates between melanoma thicker and thinner than 1 mm,” Journal of the European Academy of Dermatology and Venereology, vol. 24, no. 9, pp. 1105–1108, 2010.
[15]  O. Catalano and A. Siani, “Cutaneous melanoma: role of ultrasound in the assessment of locoregional spread,” Current Problems in Diagnostic Radiology, vol. 39, no. 1, pp. 30–36, 2010.
[16]  K. Hoffmann, J. Jung, S. El Gammal, and P. Altmeyer, “Malignant melanoma in 20-MHz B scan sonography,” Dermatology, vol. 185, no. 1, pp. 49–55, 1992.
[17]  D. Jasaitiene, S. Valiukeviciene, G. Linkeviciute, R. Raisutis, E. Jasiuniene, and R. Kazys, “Principles of high-frequency ultrasonography for investigation of skin pathology,” Journal of the European Academy of Dermatology and Venereology, vol. 25, no. 4, pp. 375–382, 2011.
[18]  V. Kaikaris, D. Samsanavi?ius, K. Maslauskas et al., “Measurement of melanoma thickness—comparison of two methods: ultrasound versus morphology,” Journal of Plastic, Reconstructive and Aesthetic Surgery, vol. 64, no. 6, pp. 796–802, 2011.
[19]  K. Wheatley, N. Ives, B. Hancock, M. Gore, A. Eggermont, and S. Suciu, “Does adjuvant interferon-α for high-risk melanoma provide a worthwhile benefit? A meta-analysis of the randomised trials,” Cancer Treatment Reviews, vol. 29, no. 4, pp. 241–252, 2003.
[20]  D. Pirard, M. Heenen, C. Melot, and P. Vereecken, “Interferon alpha as adjuvant postsurgical treatment of melanoma: a meta-analysis,” Dermatology, vol. 208, no. 1, pp. 43–48, 2004.
[21]  M. B. Lens and M. Dawes, “Interferon alfa therapy for malignant melanoma: a systematic review of randomized controlled trials,” Journal of Clinical Oncology, vol. 20, no. 7, pp. 1818–1825, 2002.
[22]  S. Mocellin, S. Pasquali, C. R. Rossi, and D. Nitti, “Interferon alpha adjuvant therapy in patients with high-risk melanoma: a systematic review and meta-analysis,” Journal of the National Cancer Institute, vol. 102, no. 7, pp. 493–501, 2010.
[23]  A. M. Eggermont, S. Suciu, R. MacKie et al., “Post-surgery adjuvant therapy with intermediate doses of interferon alfa 2b versus observation in patients with stage IIb/III melanoma (EORTC 18952): randomised controlled trial,” Lancet, vol. 366, no. 9492, pp. 1189–1196, 2005.
[24]  J. W. Chang, “Cutaneous melanoma: Taiwan experience and literature review,” Chang Gung Medical Journal, vol. 33, no. 6, pp. 602–612, 2010.
[25]  M. K. Khan, N. Khan, A. Almasan, and R. Macklis, “Future of radiation therapy for malignant melanoma in an era of newer, more effective biological agents,” Journal of OncoTargets and Therapy, vol. 4, pp. 137–148, 2011.
[26]  Y. Harada, K. Ogawa, Y. Irie et al., “Ultrasound activation of TiO2 in melanoma tumors,” Journal of Controlled Release, vol. 20, no. 149, pp. 190–195, 2011.
[27]  N. Lassau, S. Mercier, S. Koscielny et al., “Prognostic value of high-frequency sonography and color Doppler sonography for the preoperative assessment of melanomas,” American Journal of Roentgenology, vol. 172, no. 2, pp. 457–461, 1999.
[28]  N. Lassau, S. Koscielny, M. F. Avril et al., “Prognostic value of angiogenesis evaluated with high-frequency and color doppler sonography for preoperative assessment of melanomas,” American Journal of Roentgenology, vol. 178, no. 6, pp. 1547–1551, 2002.
[29]  C. Voit, A. C. van Akkooi, G. Sch?fer-Hesterberg et al., “Ultrasound morphology criteria predict metastatic disease of the sentinel nodes in patients with melanoma,” Journal of Clinical Oncology, vol. 28, no. 5, pp. 847–852, 2010.
[30]  C. A. Voit, A. C. van Akkooi, G. Sch?fer-Hesterberg et al., “Rotterdam Criteria for sentinel node (SN) tumor burden and the accuracy of ultrasound (US)-guided fine-needle aspiration cytology (FNAC): can US-guided FNAC replace SN staging in patients with melanoma?” Journal of Clinical Oncology, vol. 27, no. 30, pp. 4994–5000, 2009.
[31]  N. Lassau, A. Spatz, M. F. Avril et al., “Value of high-frequency US for preoperative assessment of skin tumors,” Radiographics, vol. 17, no. 6, pp. 1559–1565, 1997.
[32]  L. Rubaltelli, V. Beltrame, A. Tregnaghi, E. Scagliori, A. C. Frigo, and R. Stramare, “Contrast-enhanced ultrasound for characterizing lymph nodes with focal cortical thickening in patients with cutaneous melanoma,” American Journal of Roentgenology, vol. 196, no. 1, pp. W8–W12, 2011.
[33]  L. Chami, N. Lassau, M. Chebil, and C. Robert, “Imaging of melanoma: Usefulness of ultrasonography before and after contrast injection for diagnosis and early evaluation of treatment,” Clinical, Cosmetic and Investigational Dermatology, vol. 4, pp. 1–6, 2011.
[34]  N. Lassau, L. Chami, M. Chebil et al., “Dynamic contrast-enhanced ultrasonography (DCE-US) and anti-angiogenic treatments,” Discovery Medicine, vol. 11, no. 56, pp. 18–24, 2011.
[35]  N. Lassau, M. Chebil, L. Chami, S. Bidault, E. Girard, and A. Roche, “Dynamic contrast-enhanced ultrasonography (DCE-US): a new tool for the early evaluation of antiangiogenic treatment,” Targeted Oncology, vol. 5, no. 1, pp. 53–58, 2010.
[36]  N. Lassau, L. Chami, B. Benatsou, P. Peronneau, and A. Roche, “Dynamic contrast-enhanced ultrasonography (DCE-US) with quantification of tumor perfusion: a new diagnostic tool to evaluate the early effects of antiangiogenic treatment,” European Radiology, Supplement, vol. 17, supplement 6, pp. F89–F98, 2007.
[37]  S. J. Kirkpatrick, R. K. Wang, D. D. Duncan, M. Kulesz-Martin, and K. Lee, “Imaging the mechanical stiffness of skin lesions by in vivo acousto-optical elastography,” Optics Express, vol. 16, no. 14, pp. 9770–9779, 2006.


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