Publication date: Oct 07, 2019
Cutaneous melanoma is one of the most severe skin diseases. Nodular melanoma is the second melanoma subtype in order of frequency. The prognosis of skin melanoma depends on the vertical growth of the tumor (Breslow index). For this measurement, excisional biopsy is strongly recommended. This is however an invasive procedure, and may result in damage to the lymphatic drainage system. The HFUS system, given its high resolution capacity, can be extremely useful for determining tumor thickness in the preoperative phase. The aim of this preliminary study is to define the role of HFUS for the nodular skin melanoma Breslow thickness in adults before surgery making a comparison with histological features.
In this study were evaluated 14 melanocytic lesions (8 male and 6 female) with dermatoscopic clinical features strongly indicative of nodular melanoma of which 7 lesions excisional biopsy was requested. Ultrasounds were performed preoperatively. The images were acquired through the first ultrasound scanner with ultra high frequency probes (range from 50MHz to 70 MHz) available on the market under the EEC mark (Vevo “MD, FUJIFILM Visual Sonics, Amsterdam, the Netherlands) equipped with a linear probe of 50-70 MHz.
From ultrasonographic analysis of 14 nodular melanoma thickness were determined for the presence of two hyperechogenic laminae, separated by a hypo / anechoic space. Twelve lesions were in situ while the other two lesions showed ultrasonography the satellite lesions (less than two centimeters from the primary lesion) and in transit (localizable to more than two centimeters from the primary lesion).Four lesions of these were ulcerated. 0n 7 lesions have made comparison between the thickness calculated with this method, and that obtained on the bioptic piece, has shown in all cases the presence of a positive concordance.
If further studies are needed to support its widespread clinical use, we believe that, in expert hands and with a interdisciplinary team, HFUS are already capable to reliably calculate a Breslow index in the large majority of patients with cutaneous melanoma.
Reginelli, A., Belfiore, M.P., Russo, A., Turriziani, F., Moscarella, E., Troiani, T., Brancaccio, G., Ronchi, A., Giunta, E., Sica, A., Iovino, F., Ciardiello, F., Franco, R., Argenziano, G., Grassi, R., and Cappabianca, S. A preliminary study for quantitative assessment with HFUS (High Frequency ultrasound) of nodular skin melanoma Breslow thickness in adults before surgery: Interdisciplinary team experience. 24381. 2019 Curr Radiopharm.