Examination by ultrasonography (US) is a rapid, sensitive, cost-effective, and even portable technique for confirming the presence of tumors. However, US is not routinely used worldwide for the diagnostic work-up of cutaneous malignant melanoma. High-resolution US using a 6–14 MHz or 5–13 MHz linear transducer enables the preoperative assessment of tumor size and thickness. Compared with physical examination, US is also very effective in the early detection of lymph node metastases. It can be easily repeated for the follow-up of cutaneous malignant melanoma and lymph node metastases. Ultrasonographic appearance of some lymph nodes may overlap, thus producing diagnostic pitfalls. In such cases with overlapping findings, Doppler imaging and elastography may additionally facilitate the evaluation of cutaneous malignant melanoma and lymph node metastases. US-guided fine needle aspiration cytology (FNAC) finally helps to confirm ultrasonographic results, thus improving the specificity and sensitivity in difficult situations in which US alone gives unclear results in lymph node assessment.
References
[1]
Balch, C.M.; Gershenwald, J.E.; Soong, S.J.; Thompson, J.F.; Atkins, M.B.; Byrd, D.R.; Buzaid, A.C.; Cochran, A.J.; Coit, D.G.; Ding, S.; et al. Final version of 2009 AJCC melanoma staging and classification. J. Clin. Oncol. 2009, 27, 6199–6206, doi:10.1200/JCO.2009.23.4799.
[2]
Wortsman, X. Common applications of dermatologic sonography. J. Ultrasound Med. 2012, 31, 97–111.
[3]
Lassau, N.; Mercier, S.; Koscielny, S.; Avril, M.F.; Margulis, A.; Mamelle, G.; Duvillard, P.; Leclère, J. Prognostic value of high-frequency sonography and color Doppler sonography for the preoperative assessment of melanomas. AJR Am. J. Roentgenol. 1999, 172, 457–461, doi:10.2214/ajr.172.2.9930803.
[4]
Lassau, N.; Lamuraglia, M.; Koscielny, S.; Spatz, A.; Roche, A.; Leclere, J.; Avril, M.F. Prognostic value of angiogenesis evaluated with high-frequency and colour Doppler sonography for preoperative assessment of primary cutaneous melanomas: Correlation with recurrence after a 5 year follow-up period. Cancer Imag. 2006, 25, 6:24–6:29.
[5]
Robinson, J.K.; Hanke, C.W.; Siegel, D.M.; Fratila, A. Surgery of the Skin, 2nd ed. ed.; Elseier Mosby: New York, NY, USA, 2010; p. 833.
Catalano, O.; Caracò, C.; Mozzillo, N.; Siani, A. Locoregional spread of cutaneous melanoma: Sonography findings. AJR Am. J. Roentgenol. 2010, 194, 735–745, doi:10.2214/AJR.09.2422.
[8]
Voit, C.; van Akkooi, A.C.; Sch？fer-Hesterberg, G.; Schoengen, A.; Kowalczyk, K.; Roewert, J.C.; Sterry, W.; Eggermont, A.M. Ultrasound morphology criteria predict metastatic disease of the sentinel nodes in patients with melanoma. J. Clin. Oncol. 2010, 28, 847–852, doi:10.1200/JCO.2009.25.7428.
[9]
Itoh, A.; Ueno, E.; Tohno, E.; Kamma, H.; Takahashi, H.; Shiina, T.; Yamakawa, M.; Matsumura, T. Breast disease: Clinical application of US elastography for diagnosis. Radiology 2006, 239, 341–350, doi:10.1148/radiol.2391041676.
[10]
Ogata, D.; Uematsu, T.; Yoshikawa, S.; Kiyohara, Y. Accuracy of real-time ultrasound elastography in the differential diagnosis of lymph nodes in cutaneous malignant melanoma (CMM): A pilot study. Int. J. Clin. Oncol. 2013, doi:10.1007/s10147-013-0595-9.
[11]
Zhao, Q.L.; Ruan, L.T.; Zhang, H.; Yin, Y.M.; Duan, S.X. Diagnosis of solid breast lesions by elastography 5-point score and strain ratio method. Eur. J. Radiol. 2012, 81, 3245–3249, doi:10.1016/j.ejrad.2012.06.004.
[12]
Voit, C.A.; van Akkooi, A.C.; Sch？fer-Hesterberg, G.; Schoengen, A.; Schmitz, P.I.; Sterry, W.; Eggermont, A.M. 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? J. Clin. Oncol. 2009, 27, 4994–5000, doi:10.1200/JCO.2008.19.0033.
[13]
Voit, C.; Mayer, T.; Kron, M.; Schoengen, A.; Sterry, W.; Weber, L.; Proebstle, T.M. Efficacy of ultrasound B-scan compared with physical examination in follow-up of melanoma patients. Cancer 2001, 91, 2409–2416, doi:10.1002/1097-0142(20010615)91:12<2409::AID-CNCR1275>3.0.CO;2-S.
