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

Ultrasound of Skin Cancer: What We Need to Know

Ultrasound is an imaging technique that can provide critical anatomical information about malignant skin tumors that cannot be deducted by clinical examination, dermoscopy, or even biopsy. This data can support detecting and assessing the extent of the primary tumor and its differential diagnosis, surgical planning, and locoregional staging. Moreover, this non-invasive technique can help to follow-up and detect recurrences. This review aims to address the most common indications for ultrasound in skin oncology and provide a comprehensive guide to the grayscale and color-Doppler findings in cutaneous melanoma, squamous cell carcinoma, basal cell carcinoma, and other cutaneous malignant tumors.

Rationale for Using High-Frequency Ultrasound as a Routine Examination in Skin Cancer Surgery: A Practical Approach

Ultrasound and high-frequency ultrasound assessment of melanoma and non-melanoma skin cancer in the pre-therapeutical setting is becoming increasingly popular in the field of dermatosurgery and dermatooncology, as it can provide clinicians with relevant, "in vivo" parameters regarding tumor lateral and depth extension as well as potential locoregional spread, cancelling the need of more extensive imaging methods and avoiding a delay in diagnosis. Furthermore, preoperative sonography and color Doppler can aid in orienting the clinical diagnosis, being able in numerous situations to differentiate between benign and malignant lesions, which require a different therapeutic approach. This preoperative knowledge is of paramount importance for planning an individualized treatment regimen. Using sonography at the time of diagnosis, important surgical complications, such as neurovascular damage, can be avoided by performing a preoperative neurovascular mapping. Furthermore, sonography can help reduce the number of surgical steps by identifying the lesions' extent prior to surgery, but it can also spare unnecessary surgical interventions in cases of locally advanced lesions, which infiltrate the bone or already present with locoregional metastases, which usually require modern radiooncological therapies in accordance to European guidelines. With this review, we intend to summarize the current indications of sonography in the field of skin cancer surgery, which can help us improve the therapeutic attitude toward our patients and enhance patient counseling. In the era of modern systemic radiooncological therapies, sonography can help better select patients who qualify for surgical procedures or require systemic treatments due to tumoral extension.

Review of the application of the most current sophisticated image processing methods for the skin cancer diagnostics purposes

This paper presents the most current and innovative solutions applying modern digital image processing methods for the purpose of skin cancer diagnostics. Skin cancer is one of the most common types of cancers. It is said that in the USA only, one in five people will develop skin cancer and this trend is constantly increasing. Implementation of new, non-invasive methods plays a crucial role in both identification and prevention of skin cancer occurrence. Early diagnosis and treatment are needed in order to decrease the number of deaths due to this disease. This paper also contains some information regarding the most common skin cancer types, mortality and epidemiological data for Poland, Europe, Canada and the USA. It also covers the most efficient and modern image recognition methods based on the artificial intelligence applied currently for diagnostics purposes. In this work, both professional, sophisticated as well as inexpensive solutions were presented. This paper is a review paper and covers the period of 2017 and 2022 when it comes to solutions and statistics. The authors decided to focus on the latest data, mostly due to the rapid technology development and increased number of new methods, which positively affects diagnosis and prognosis.

Präoperativer Hochfrequenzultraschall: Ein zuverlässiges Managementinstrument bei nichtmelanozytärem Hautkrebs der Ohrmuschel und der Nase: Pre-operative high-frequency ultrasound: A reliable management tool in auricular and nasal non-melanoma skin cancer

Hintergrund und Zielsetzung

Das Wissen über die Tiefeninfiltration bei nichtmelanozytärem Hautkrebs (NMSC) mithilfe präoperativer Sonographie könnte den Ärzten ermöglichen, den am besten geeigneten therapeutischen Ansatz zu wählen, unnötige Operationen und teure bildgebende Verfahren zu vermeiden und die Diagnose und Behandlung nicht zu verzögern. In unserer retrospektiven, monozentrischen Studie haben wir die Nützlichkeit des Hochfrequenzultraschalls (HFUS) zur Beurteilung der Tiefeninfiltration bei aurikulären und nasalen NMSC‐Fällen untersucht und die darauffolgende Änderung des therapeutischen Ansatzes bewertet.

Patienten und Methodik

In 60 NMSC‐Fällen haben wir die Genauigkeit des HFUS bei der Erkennung von Knorpel‐ und Knocheninfiltration sowie die Korrelation sonographischer und histologischer Parameter beurteilt.

Ergebnisse

In 16,6% der Fälle wurde präoperativ eine tiefe Knorpel‐/Knochenbeteiligung oder eine lokoregionale Erkrankung identifiziert, was zu einer geänderten therapeutischen Strategie mit radioimmunologischer Behandlung anstelle von Operation führte. In zwei Fällen identifizierte der präoperative HFUS eine lokale Knorpelinfiltration, was die Anzahl der chirurgischen Eingriffe reduzierte. Bei den verbleibenden 48 Läsionen ohne Tiefeninfiltration wurde eine Korrelation von > 99% zwischen der histologischen und sonographischen Tumoreindringtiefe gefunden (p <0.001).

Schlussfolgerungen

Präoperativer HFUS beeinflusst das therapeutische Vorgehen bei NMSC, indem es eine subklinische Beteiligung tieferer Strukturen erkennt, umfangreichere diagnostische Maßnahmen vermeidet, Kosten reduziert und die Qualität der Gesundheitsversorgung verbessert. HFUS sollte in der Dermatochirurgie vor der Tumorentfernung zur optimierten Therapie und zur verbesserten Patientenberatung eingesetzt werden.

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

BACKGROUND AND OBJECTIVES

The knowledge of depth infiltration in non-melanoma skin cancer (NMSC) using pre-operative ultrasound could enable clinicians to choose the most adequate therapeutic approach, avoiding unnecessary surgeries and expensive imaging methods, delaying diagnosis and treatment. Our single-center retrospective study determined the usefulness of high-frequency ultrasound (HFUS) for depth infiltration assessment in auricular and nasal NMSC and assessed the subsequent change in therapeutic approach.

PATIENTS AND METHODS

In 60 NMSC cases, we assessed the accuracy of HFUS in cartilaginous/bone infiltration detection as well as the correlation of sonographic and histological parameters.

RESULTS

In 16.6% of cases, a deep cartilaginous/bone involvement or locoregional disease was identified pre-operatively, resulting in a changed therapeutical scheme of radio-immunological treatment rather than surgery. In two cases, pre-operative HFUS identified local cartilage infiltration, reducing the number of surgical procedures. Forty-eight remaining lesions with no depth infiltration were excised; a correlation of > 99% between the histologic and sonographic tumor depth (p<0.001) was found.

CONCLUSIONS

Pre-surgical HFUS influences the therapeutic management in NMSC by detecting subclinical involvement of deeper structures, avoiding more extensive diagnostics, reducing costs, and improving healthcare quality. High-frequency ultrasound should be implemented in dermatosurgery before tumor excision for optimized therapy and improved patient counseling.

Ultrasound Assessment of Skin Tumors Local Recurrence

Skin cancer may recur at or around the surgical site despite wide excisions. Prompt clinical and sonographic detection of local recurrence is important since subjects with relapsing melanomas or nonmelanoma malignancies can be managed efficaciously, with a relevant impact on morbidity and survival. Ultrasound is being employed with increasing frequency in the assessment of skin tumors, but most of the published articles relate to initial pretherapeutic diagnosis and staging. This review aims to offer an illustrated guide to the sonographic evaluation of locally recurring skin cancer. We introduce the topic, then we provide some sonographic tips for patient follow-up, then we describe the ultrasound findings in case of local recurrence, illustrating the main mimickers, and finally, we mention the role of ultrasound in guiding diagnostic and therapeutic percutaneous procedures.