Ultrasonographic Assessment of Depth Infiltration in Melanoma and Non‐melanoma Skin Cancer

Abstract

The preoperative assessment of infiltration depth in melanoma and non‐melanoma skin cancer by means of high‐frequency ultrasound (≥18 MhZ) is essential for optimizing the therapeutic approach in our patients. Often, histologically confirmed skin tumors are directly referred to surgical departments for resection, and sonography is increasingly helping us identify those subjects who are no longer candidates for extensive surgical interventions. In cases of deep tumor infiltration, with potential surgical failure e.g. impairment of the quality of life and significant esthetic and functional complications, preoperative sonography can guide the surgeon to withstand from an operation and decide instead in favor of less mutilating radiooncological or medical treatment options. Furthermore, in melanoma patients, the preoperative knowledge of the tumor depth is essential for the determination of the therapeutic approach, the correct safety margins and the need of a sentinelnode biopsy. We herein encourage the use of preoperative sonography in dermatologic surgery whenever possible as it represents an easy, painless, “in vivo” method, which provides clinicians with significant clinical information that can influence the therapy and improve patient compliance.

Ultrasound Assessment of Skin Tumors Local Recurrence

“…[10][11][12][13][14] Particularly, it is being employed with growing frequency in the study of skin tumors for the initial assessment, including differential diagnosis, accurate size measurement, potential invasion into deep structures, and regional staging. 1,[15][16][17][18][19][20] Infiltration of relevant anatomic structures, including fascia, muscles, cartilages, and bone cortex, can be recognized using ultrasound, helping the surgeon to choose the most appropriate approach and, in some cases, even canceling the need for surgery in favor of other radio-oncological therapies. 21 Ultrasound is now employed for routine follow-up of high-risk cases or in case of clinically suspected tumor recurrence.…”

Pre‐operative high‐frequency ultrasound: a reliable management tool in auricular and nasal non‐melanoma skin cancer

“…Whereas many of the NMSC cases we see on a daily basis are not therapeutically challenging, a certain number of patients present with high‐risk, deep infiltrating tumors in aesthetically challenging areas such as the nose or ears, where pre‐operative sonography can aid in the therapeutic management. By precise sonographic imaging, we can assess the tumor extension margins and tumor depth with high accuracy, and thus reduce the size of the surgical defects by detailed pre‐operative knowledge of the necessary safety margin, while also preserving the oncological radicality 14,21,22 …”

“…Often, patients with histologically confirmed NMSCs are directly referred to surgical departments for resection without further imaging. Sonography is increasingly helping us identify those subjects who are no longer candidates for extensive surgical interventions but require an interdisciplinary approach 22 …”

“…By precise sonographic imaging, we can assess the tumor extension margins and tumor depth with high accuracy, and thus reduce the size of the surgical defects by detailed pre-operative knowledge of the necessary safety margin, while also preserving the oncological radicality. 14,21,22 Furthermore, HFUS (>15 MHz) has been shown in the pre-operative setting to be able to differentiate between different histologic tumor patterns, such as infiltrative or non-infiltrative BCCs. This could also influence surgical planning, as infiltrative tumors usually require more extensive 2-step micrographic surgery, whereas solid, non-infiltrative lesions may also be treated by standard micrographic excision with direct closure.…”

“…Sonography is increasingly helping us identify those subjects who are no longer candidates for extensive surgical interventions but require an interdisciplinary approach. 22 As shown in Figure 2a,b, many tumors with deep infiltration up to the bone are clinically inapparent, and these cases are easily underestimated as operable, with the true extent of tumor invasion only being revealed intraoperatively. Especially for cases in which tumors are located in areas with little subcutaneous tissue and thin skin, preoperative HFUS should become routine for surgeons.…”