Preoperative 15-MHz Ultrasound Assessment of Tumor Thickness in Malignant Melanoma

Canedo, I. Fernández; Martı́n, Miguel Ángel; Liébana, R. Fúnez; Rivas-Ruiz, Francisco; Eguren, G. Blanco; Sanchez, N.

doi:10.1016/j.adengl.2012.06.025

Cited by 26 publications

(14 citation statements)

References 19 publications

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“…For malignant melanoma (MM), studies have shown that US can preoperatively evaluate tumor thickness in vivo , the sonographic tumor thickness correlating with the histologic Breslow index [42–46]. We previously found a high correlation level (> 98 %) between sonographic and histopathologic depth measurements.…”

Section: Ultrasonography In Dermatologic Surgerymentioning

confidence: 99%

Ultrasonography in dermatologic surgery: revealing the unseen for improved surgical planning

Crişan

Wortsman

Alfageme

et al. 2022

J Deutsche Derma Gesell

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Summary Ultrasonography (US) is a modern, in vivo imaging method, which is increasingly being used in dermatology as a complementary tool to clinical examination and dermoscopy. At higher frequencies (15 MHz and above), US is an established method for assessing benign and malignant skin lesions, locoregional staging, monitoring the therapeutic efficacy in various inflammatory skin conditions, and patient follow‐up. One field, which may increasingly benefit from performant imaging techniques such as US is dermatologic surgery. Preoperative imaging of cutaneous tumors, inflammatory skin conditions (hidradenitis suppurativa, abscesses, etc.), or nail pathology provide dermatologic surgeons with relevant information for an optimal surgical planning, identifying potential complex aspects which might require interdisciplinary approaches, herein sparing unnecessary surgical interventions and increasing patients' compliance. In this review, we discuss the increasing significance of US in the field of dermatologic surgery, as well as the spectrum of cutaneous pathology where sonography can aid in the preoperative setting to provide a more precise, individualized surgical planning for better counseling to our patients and improved surgical results.

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Section: Ultrasonography In Dermatologic Surgerymentioning

confidence: 99%

Ultrasonography in dermatologic surgery: revealing the unseen for improved surgical planning

Crişan

Wortsman

Alfageme

et al. 2022

J Deutsche Derma Gesell

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“…Für das maligne Melanom (MM) zeigten mehrere Publikationen, dass die in vivo präoperative sonographische Messung der Tumoreindringtiefe (Breslow‐Index) mit dem histologischen Breslow‐Index gut korreliert [42–46]. Unsere Gruppe fand eine hohe Korrelation (> 98 %) zwischen sonographischen und histopathologischen Tiefenmessungen bei malignen Melanomen.…”

Section: Ultraschalldiagnostik In Der Dermatochirurgieunclassified

Ultraschall in der Dermatochirurgie: Enthüllen des Verborgenen für optimierte chirurgische Planung

Crişan

Wortsman²,

Alfageme

et al. 2022

J Deutsche Derma Gesell

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Zusammenfassung Die Sonographie ist ein modernes bildgebendes In‐vivo‐Verfahren, das in der Dermatologie zunehmend als ergänzendes Instrument zur klinischen Untersuchung und Dermatoskopie eingesetzt wird. Bei höheren Frequenzen (≥ 15 MHz) ist die Ultraschalldiagnostik eine etablierte Methode zur Beurteilung gutartiger und bösartiger Hautläsionen, lokoregionärer Lymphknoten, Überwachung der therapeutischen Wirksamkeit bei verschiedenen entzündlichen Hauterkrankungen und zur Patientennachsorge. Ein Bereich, der zunehmend von leistungsfähigen, bildgebenden Verfahren wie den Ultraschallsystemen profitieren könnte, ist die Dermatochirurgie. Die präoperative sonographische Darstellung von Hauttumoren, entzündlichen Hauterkrankungen (zum Beispiel Akne inversa, Abszesse) oder unterschiedlicher Nageltumoren liefert dem Chirurgen relevante präoperative Informationen und eine genaue anatomische Zuordnung für eine optimale chirurgische Planung. Zudem ermöglicht es die Identifizierung von potenziell komplexen Aspekten, die bei einer OP‐Planung berücksichtigt werden müssen, welche manchmal ein interdisziplinäres Vorgehen erfordern könnten. Dies kann unnötige operative Schritte vermeiden und somit die Patienten‐Compliance erhöhen. In dieser Übersicht diskutieren wir die zunehmende Bedeutung der Ultraschalldiagnostik in der Dermatochirurgie sowie das Spektrum der Hauterkrankungen, bei dem die präoperative Sonographie eine präzisere, individuellere Operationsplanung zur besseren Beratung unserer Patienten ermöglicht.

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“…The lack of specificity for the guidance for clinicians when dealing with such a wide range of tumors may lead to much confusion, especially as tumor thickness is such an important indicator of disease progression and prognosis [2][3][4]. Given such a generalized approach to the treatment of cutaneous malignant melanomas, we are compelled to summarize the potential flaws that the AJCC recommendations fail to address:…”

Section: The Treatment Of Intermediate Thick Cutaneous Melanomas Ofmentioning

confidence: 99%

“…Our presented patient with a 4mm Breslow thickness could be treated with a defined 2 cm surgical margin in all directions in one session if we were to employ the OSMS regimen. Although histopathological verification of tumor thickness is the gold standard and the primary reason for employing a two-step approach, the use of high-resolution ultrasound to determine preoperative thickness is being increasingly used and has shown to correlate well with histologic Breslow thickness [3,[4][5][6][7].In fact, correlation of the complete clinical, dermatological and high-resolution ultrasound data provides a highly accurate preoperative estimation of Breslow thickness [4,6].…”

Section: Breslow Thicknessmentioning

confidence: 99%

Borderline Intermediate Thickness Cutaneous Melanoma Class B: Isn’t it Time for Personalised One Step Surgical Approach as Standard Clinical Behaviour?

LJ¹,

Oliveira²,

Jw³

et al. 2021

CRDOA

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We present a 40-year-old female who visited our clinic with a solitary lesion on the posterolateral aspect of the lower left leg (Figure 1a). She noticed a progressive change in the size and shape of the lesion and decided to consult a dermatologist in March 2021. The patient had a history of Hashimoto’s thyroiditis that was well-controlled onlevothyroxine. No other comorbidities were reported and she was otherwise healthy. During the clinical examination a single pigmented patch measuring 2.5 cm in greatest diameter was identified. Morphologically the lesion was asymmetrical with irregular borders and uneven colour. At the centre, an exudative, ulcerated nodule was also noted (Figure1a-f). Clinical and dermatoscopic findings were consistent with the diagnosis of a superficial spreading cutaneous melanoma. Ultrasound diagnostics of the abdominal cavity and retroperitoneal organs showed no signs of tumor spread. Chest radiography was also within normal limits. Laboratory testing showed an elevated uric acid level of 456 μmol/l (reference range 142 - 340 μmol/l), but otherwise all other parameters were normal. Following the recommended American Joint Committee on Cancer (AJCC) guidelines, we performed a primary resection with 0.5 cm margins in all directions. The resected tissue was subsequently sent for histopathological evaluation and confirmed the diagnosis of borderline intermediate thickness malignant melanoma - class B, 4 mm Breslow thickness, Clark IV, (pT4BN0M0) (Figure2a-d). There was high mitotic activity but no spontaneous regression, insignificant lymphocytic stromal reaction and clear resection margins. Post diagnostic workup, including chest and abdominal CT, showed no signs of metastatic dissemination. One week later, the patient was sent to the National Oncology Hospital for re-excision and Sentinel Lymph Node Biopsy (SLNB). The re-excision of additional 2cm from the previous surgical scar was conducted in parallel with removal of the draining sentinel lymph node (Figures 3a & 3d). The closure of the defect after re-excision led to the unfortunate complication of wound dehiscence and failure to close successfully (Figure 3b-c). However, after several sessions of debridement, cleansing, rebandaging and administration of antibiotics, there was visible improvement with subsequent resolution(Figure 3d-f). Since that time, she has been in excellent condition, and no complications have been reported to date.

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Preoperative 15-MHz Ultrasound Assessment of Tumor Thickness in Malignant Melanoma

Cited by 26 publications

References 19 publications

Ultrasonography in dermatologic surgery: revealing the unseen for improved surgical planning

Ultrasonography in dermatologic surgery: revealing the unseen for improved surgical planning

Ultraschall in der Dermatochirurgie: Enthüllen des Verborgenen für optimierte chirurgische Planung

Borderline Intermediate Thickness Cutaneous Melanoma Class B: Isn’t it Time for Personalised One Step Surgical Approach as Standard Clinical Behaviour?

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