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Vergilio MM, Monteiro E Silva SA, Jales RM, Leonardi GR. High-frequency ultrasound as a scientific tool for skin imaging analysis. Exp Dermatol 2021; 30:897-910. [PMID: 33905589 DOI: 10.1111/exd.14363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 04/09/2021] [Accepted: 04/21/2021] [Indexed: 01/07/2023]
Abstract
Ultrasonic imaging is one of the most important diagnostic tools in clinical medicine due to its cost, availability and good correlation with pathological results. High-frequency ultrasound (HFUS) is a technique used in skin science that has been little explored, especially in comparison with other sites and imaging techniques. HFUS shows real-time images of the skin layers, appendages and skin lesions in vivo and can significantly contribute to advances in skin science. This review summarizes the potential applications of HFUS in dermatology and cosmetology, with a focus on quantitative tools that can be used to assess various skin conditions. Our findings showed that HFUS imaging is a reproducible and powerful tool for the diagnosis, clinical management and therapy monitoring of skin conditions. It is also a helpful tool for assessing the performance of dermatological products. This technique may eventually become essential for evaluating the performance of dermatological and cosmetic products.
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Affiliation(s)
- Mariane Massufero Vergilio
- Graduate Program in Internal Medicine, School of Medical Sciences - University of Campinas (UNICAMP), Campinas, Brazil
| | - Silas Arandas Monteiro E Silva
- Graduate Program in Pharmaceutical Sciences, School of Pharmaceutical Sciences - University of Campinas (UNICAMP), Campinas, Brazil
| | - Rodrigo Menezes Jales
- Radiology Service of the Women´s Hospital "Prof. Dr. José Aristodemo Pinotti", Department of Gynecology and Obstetrics of School of Medical Sciences of Campinas State University (UNICAMP), São Paulo, Brazil
| | - Gislaine Ricci Leonardi
- Graduate Program in Internal Medicine, School of Medical Sciences - University of Campinas (UNICAMP), Campinas, Brazil.,Graduate Program in Pharmaceutical Sciences, School of Pharmaceutical Sciences - University of Campinas (UNICAMP), Campinas, Brazil
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2
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Polańska A, Jenerowicz D, Paszyńska E, Żaba R, Adamski Z, Dańczak-Pazdrowska A. High-Frequency Ultrasonography-Possibilities and Perspectives of the Use of 20 MHz in Teledermatology. Front Med (Lausanne) 2021; 8:619965. [PMID: 33693015 PMCID: PMC7937737 DOI: 10.3389/fmed.2021.619965] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 01/11/2021] [Indexed: 12/28/2022] Open
Abstract
High-frequency ultrasonography (HF-USG) is a non-invasive and in vivo method of visualization of the skin and upper part of subcutaneous tissue based on ultrasounds above 20 MHz. Although initially HF-USG was introduced to measure skin thickness, it currently gained widespread acceptance in dermato-oncology, primarily when used to determine skin tumor margins. Moreover, its application in different dermatology fields is known, particularly as a rapidly evolving method in the objective evaluation of the severity of various chronic skin diseases. Among different specialties, teledermatology belongs to leading and continually developing areas of successful telemedicine applications. Various skin conditions are visible to the human eye, which makes them particularly suitable for telemedicine. However, HF-USG enables specialists to look into deeper skin layers, thus extending diagnostic options. On the other hand, teledermatology creates the possibility of sending images for consultation and facilitates the therapeutic decision as HF-USG can be used in an asynchronous store and forward manner. It seems that HF-USG and teledermatology may be regarded as a truly matched pair. The aim of this work is to present current applications of 20-MHz ultrasonography in dermatology, including skin neoplasms and chronic skin diseases. Moreover, the authors aimed to analyze the possibilities of HF-USG use as a valuable tool in teledermatology, especially in diagnosing and monitoring patients suffering from long-lasting skin conditions.
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Affiliation(s)
- Adriana Polańska
- Department of Dermatology and Venereology, Poznań University of Medical Sciences, Poznań, Poland
| | - Dorota Jenerowicz
- Department of Dermatology, Poznań University of Medical Sciences, Poznań, Poland
| | - Elżbieta Paszyńska
- Department of Integrated Dentistry, Poznań University of Medical Sciences, Poznań, Poland
| | - Ryszard Żaba
- Department of Dermatology and Venereology, Poznań University of Medical Sciences, Poznań, Poland
| | - Zygmunt Adamski
- Department of Dermatology, Poznań University of Medical Sciences, Poznań, Poland
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Hindelang B, Aguirre J, Schwarz M, Berezhnoi A, Eyerich K, Ntziachristos V, Biedermann T, Darsow U. Non-invasive imaging in dermatology and the unique potential of raster-scan optoacoustic mesoscopy. J Eur Acad Dermatol Venereol 2019; 33:1051-1061. [PMID: 30422337 PMCID: PMC6563473 DOI: 10.1111/jdv.15342] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 10/18/2018] [Indexed: 12/25/2022]
Abstract
In recent years, several non‐invasive imaging methods have been introduced to facilitate diagnostics and therapy monitoring in dermatology. The microscopic imaging methods are restricted in their penetration depth, while the mesoscopic methods probe deeper but provide only morphological, not functional, information. ‘Raster‐scan optoacoustic mesoscopy’ (RSOM), an emerging new imaging technique, combines deep penetration with contrast based on light absorption, which provides morphological, molecular and functional information. Here, we compare the capabilities and limitations of currently available dermatological imaging methods and highlight the principles and unique abilities of RSOM. We illustrate the clinical potential of RSOM, in particular for non‐invasive diagnosis and monitoring of inflammatory and oncological skin diseases.
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Affiliation(s)
- B Hindelang
- Department of Dermatology and Allergy, Technische Universität München, Munich, Germany.,Chair of Biological Imaging, Technische Universität München, Munich, Germany.,Institute of Biological and Medical Imaging, Helmholtz Zentrum München, Neuherberg, Germany
| | - J Aguirre
- Chair of Biological Imaging, Technische Universität München, Munich, Germany.,Institute of Biological and Medical Imaging, Helmholtz Zentrum München, Neuherberg, Germany
| | - M Schwarz
- Chair of Biological Imaging, Technische Universität München, Munich, Germany.,Institute of Biological and Medical Imaging, Helmholtz Zentrum München, Neuherberg, Germany.,iThera Medical GmbH, Munich, Germany
| | - A Berezhnoi
- Chair of Biological Imaging, Technische Universität München, Munich, Germany.,Institute of Biological and Medical Imaging, Helmholtz Zentrum München, Neuherberg, Germany
| | - K Eyerich
- Department of Dermatology and Allergy, Technische Universität München, Munich, Germany
| | - V Ntziachristos
- Chair of Biological Imaging, Technische Universität München, Munich, Germany.,Institute of Biological and Medical Imaging, Helmholtz Zentrum München, Neuherberg, Germany
| | - T Biedermann
- Department of Dermatology and Allergy, Technische Universität München, Munich, Germany
| | - U Darsow
- Department of Dermatology and Allergy, Technische Universität München, Munich, Germany
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4
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Current applications of high-frequency ultrasonography in dermatology. Postepy Dermatol Alergol 2017; 34:535-542. [PMID: 29422817 PMCID: PMC5799756 DOI: 10.5114/ada.2017.72457] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 11/08/2016] [Indexed: 11/17/2022] Open
Abstract
The era of ultrasounds in dermatology started in 1979, when pioneering use of 15 MHz by Alexander and Miller in measuring the skin thickness was introduced. Since then, some new applications of high-frequency ultrasonography (HF-USG) have emerged providing the clinicians with an extra hand in their everyday practice. The main advantages of HF-USG include the possibility of real-time imaging, measurements of morphological and physiological aspects of the skin, safety associated with the use of non-ionizing media as well as the lack of contraindications to its performance. Currently the main clinical use of HF-USG in dermatology regards preoperative assessment of the depth of invasion in melanomas and basal cell carcinomas. The ultrasound image analysis allows noninvasive follow-up of inflammatory skin diseases, like atopic dermatitis, psoriasis and may be used for monitoring effectiveness of therapy in skin lymphomas and sclerotic skin diseases.
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Abstract
Ultrasound above 14 MHz images epidermis, dermis, and subcutaneous tissues in real time. Tumor depth is ascertained with B-mode. Three-dimensional imaging depicts nonpalpable, in-transit, and satellite lesions. Doppler blood flow technologies measure tumor neovascularity and map vascular structures. Three-dimensional Doppler histogram reconstruction measures tumor aggression and metastatic potential proportional to the percentage of malignant vessels. Subcutaneous investigation reveals nonpalpable metastatic disease and nodal basin lymphadenopathy. Adjacent nerves may be studied. Preservation of the fat-fascia border refines surgical staging of deeper malignancies. Image-guided biopsy is facilitated. Treatment under image guidance is optimized with radiation and various photo and thermal technologies.
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Affiliation(s)
- Robert L Bard
- Bard Cancer Center, 121 East 60th Street, New York, NY 10022, USA.
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Kučinskienė V, Samulėnienė D, Gineikienė A, Raišutis R, Kažys R, Valiukevičienė S. Preoperative assessment of skin tumor thickness and structure using 14-MHz ultrasound. MEDICINA-LITHUANIA 2014; 50:150-5. [PMID: 25323542 DOI: 10.1016/j.medici.2014.08.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Revised: 06/03/2014] [Accepted: 06/03/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The aim of this study was to compare the relationship between skin tumor thickness and homogeneity and to evaluate the accuracy of 14-MHz ultrasound while measuring the thickness of different skin tumors. MATERIAL AND METHODS The ultrasonographic and histological analysis of 72 skin tumors was performed. Preoperative vertical tumor thickness (T) and structure of 12 melanomas, 34 melanocytic nevi and 26 basal cell carcinomas was assessed by 14-MHz ultrasonography. After the tumors were excised the vertical thickness measurement (Breslow index, pT) was performed by pathologist. According to the histological thickness all skin tumors were divided to thin (≤1mm) and thick (>1mm). The accuracy of the 14-MHz ultrasound measurements and correlation between the ultrasonographic and histological tumor thickness were estimated. RESULTS Homogeneous structure was assessed for all thin (≤1mm) and the majority (81.3%) of thick (>1mm) melanocytic skin tumors. Nonhomogeneous structure was estimated in thin and thick basal cell carcinomas, accordingly 42.9% and 31.9%. Measurements of T and pT correlated moderately in thick (>1mm) tumors (r=0.694), while in thin (≤1mm) tumors correlation was low (r=0.336). Moderate correlation between ultrasonographic and histological thickness was computed for melanocytic skin tumors as well as for basal cell carcinomas (r=0.564 and r=0.690). CONCLUSIONS Medium frequency ultrasound is not a reliable tool for the precise measurement of thin (≤1mm) skin tumors. Ultrasonography using a 14-MHz frequency transducer enables more precisely to measure the thickness of basal cell carcinoma than melanocytic skin tumors. The 14-MHz ultrasound is support tool to suggest the morphologic type of skin tumor.
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Affiliation(s)
- Vesta Kučinskienė
- Department of Skin and Venereal Diseases, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
| | - Daiva Samulėnienė
- Department of Skin and Venereal Diseases, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Aistė Gineikienė
- Department of Skin and Venereal Diseases, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Renaldas Raišutis
- Ultrasound Institute, Kaunas University of Technology, Kaunas, Lithuania
| | - Rymantas Kažys
- Ultrasound Institute, Kaunas University of Technology, Kaunas, Lithuania
| | - Skaidra Valiukevičienė
- Department of Skin and Venereal Diseases, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
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Alfageme Roldán F. Ultrasound skin imaging. ACTAS DERMO-SIFILIOGRAFICAS 2014; 105:891-9. [PMID: 24838227 DOI: 10.1016/j.ad.2013.11.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Revised: 11/18/2013] [Accepted: 11/24/2013] [Indexed: 01/26/2023] Open
Abstract
The interaction of high-frequency ultrasound waves with the skin provides the basis for noninvasive, fast, and accessible diagnostic imaging. This tool is increasingly used in skin cancer and inflammatory conditions as well as in cosmetic dermatology. This article reviews the basic principles of skin ultrasound and its applications in the different areas of dermatology.
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Affiliation(s)
- F Alfageme Roldán
- Servicio de Dermatología, Hospital Universitario Puerta de Hierro Majadahonda, Universidad Autónoma de Madrid, Madrid, España.
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Ulrich J, van Akkooi AJC, Eggermont AMM, Voit C. New developments in melanoma: utility of ultrasound imaging (initial staging, follow-up and pre-SLNB). Expert Rev Anticancer Ther 2014; 11:1693-701. [DOI: 10.1586/era.11.115] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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10
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Schäfer-Hesterberg G, Schoengen A, Sterry W, Voit C. Use of ultrasound to early identify, diagnose and localize metastases in melanoma patients. Expert Rev Anticancer Ther 2014; 7:1707-16. [DOI: 10.1586/14737140.7.12.1707] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Fernández Canedo I, de Troya Martín M, Fúnez Liébana R, Rivas Ruiz F, Blanco Eguren G, Blázquez Sánchez N. Preoperative 15-MHz ultrasound assessment of tumor thickness in malignant melanoma. ACTAS DERMO-SIFILIOGRAFICAS 2013; 104:227-31. [PMID: 22938997 DOI: 10.1016/j.ad.2012.06.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Revised: 06/24/2012] [Accepted: 06/27/2012] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Tumor thickness is of great importance in the management of cutaneous malignant melanoma (MM): this variable not only affects prognosis but is also a key factor in planning surgical margins and selecting candidates for sentinel node biopsy. Breslow depth is the standard histologic measure of thickness, but technological advances have provided imaging techniques such as cutaneous ultrasound that can potentially assess tumor thickness and enable prompt initiation of definitive treatment. OBJECTIVES a) To evaluate the utility of ultrasound assessment of tumor thickness in MM, and b) to analyze histologic variables that affect ultrasound assessments of thickness. MATERIALS AND METHODS Retrospective study of a consecutive series of 79 primary cutaneous MMs in which tumor thickness had been assessed by 15-MHz ultrasound before surgery. We gathered data from histology reports, studying Breslow depth and the presence of ulceration, regression, inflammatory infiltrate, and associated nevi. Correlation coefficients were calculated to evaluate the strength of association between Breslow depth and thickness assessed by ultrasound. We also calculated the sensitivity, specificity, and positive and negative predictive values of ultrasound measurement in the diagnosis of MMs more than 1mm thick. Associations between histologic variables and the overestimation of thickness by ultrasound were also analyzed. RESULTS The 79 primary MMs studied had a mean (SD) Breslow depth of 0.8 (1.4) mm. There was moderate correlation and agreement between Breslow depth and the ultrasound assessment of thickness (Pearson correlation coefficient, 0.678; intraclass correlation coefficient, 0.78). The tendency of ultrasound to overestimate thickness was nonsignificantly related to the presence of a moderate to intense infiltrate and associated nevi (P>.05). The sensitivity of ultrasound for the diagnosis of MM over 1mm thick was 82%; specificity was 80%, and positive and negative predictive values were 54% and 94%, respectively. CONCLUSIONS Ultrasound imaging quite correctly identifies thin MMs and can be useful for planning adequate surgical margins; however, there are limitations on its usefulness in the diagnosis of thick MMs. Additional studies are required to confirm whether certain histologic characteristics, such as the presence of a moderate to intense inflammatory infiltrate or associated nevi can lead to overestimation of thickness by ultrasound, limiting the clinical utility of this imaging technique in MM management.
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Affiliation(s)
- I Fernández Canedo
- Servicio de Dermatología, Hospital Costa del Sol, Marbella, Málaga, Spain.
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14
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15
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Sonography of the primary cutaneous melanoma: a review. Radiol Res Pract 2012; 2012:814396. [PMID: 22550586 PMCID: PMC3328161 DOI: 10.1155/2012/814396] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Revised: 10/11/2011] [Accepted: 11/13/2011] [Indexed: 11/21/2022] Open
Abstract
The diagnosis and management of primary cutaneous melanoma have traditionally relied on clinical and histological characteristics. Nevertheless, in recent years there has been a significant growth in the usage of ultrasound for studying the cutaneous layers. Thus, the present paper focuses on the primary lesion, its sonographic characteristics, the potential benefits of early imaging, and the new developments on the ultrasound field applied to cutaneous melanoma.
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Kaikaris V, Samsanavičius D, Kęstutis Maslauskas, Rimdeika R, Valiukevičienė S, Makštienė J, Pundzius J. Measurement of melanoma thickness--comparison of two methods: ultrasound versus morphology. J Plast Reconstr Aesthet Surg 2010; 64:796-802. [PMID: 21123126 DOI: 10.1016/j.bjps.2010.10.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2010] [Revised: 09/30/2010] [Accepted: 10/11/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The aim of our study was to investigate the association between non-invasive ultrasound examination and morphologic test results in the measurement of cutaneous melanoma thickness influencing surgical treatment strategy. METHODS Our prospective clinical study has been conducted in the Clinic of Plastic and Reconstructive Surgery of Kaunas University of Medicine Hospital (KUMH) since January 2004 until October 2008. A total of 100 patients with a clear clinical diagnosis of stage I-II cutaneous melanoma were enrolled in this study. Melanoma depth was measured using a linear 14-MHz frequency ultrasound sensor (Toshiba Xario XG). Surgically removed fragments of skin-subcutaneous tissue were fixated using 10% formalin solution in the operating theatre, and sent to KUMH Clinic of Pathological Anatomy. The most informative sections were analysed for tumour thickness, according to Breslow, as well as tumour type, vascular and lymphatic invasion and dissemination. A comparative data analysis of melanoma thickness measured by ultrasound (T) preoperatively and histologically estimated cutaneous melanoma (CM) thickness according to Breslow (pT) using the Bland-Altman method was performed. RESULTS Higher mean difference of melanoma thickness (60 μm) between T and pT measurements was found when tumour thickness matched pT1 and pT2 categories. In cases of CM depth exceeding 2mm, mean difference of measurements between CM thickness determined by ultrasound and histological examination was lower (30 μm). Data regression analysis showed that correlation between T and pT measurements was lower when CM was thinner (1-2 mm) (Pearson's correlation coefficient, r: 0.283). In cases of thicker melanoma (>2 mm), strong and statistically significant (p<0.0001) correlation (r: 0.869) was observed. CONCLUSIONS Correlation between melanoma thickness measured using a linear 14-MHz frequency ultrasound sensor and histologically estimated melanoma thickness according to Breslow was lower if melanoma was thinner (1-2 mm). However, in cases of thicker melanoma (>2 mm), very strong correlation between measurements was observed.
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Affiliation(s)
- Vygintas Kaikaris
- Department of Plastic and Reconstructive Surgery, Kaunas University of Medicine, Eivenių 2,50009 Kaunas, Lithuania.
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Jasaitiene D, Valiukeviciene S, Linkeviciute G, Raisutis R, Jasiuniene E, Kazys R. Principles of high-frequency ultrasonography for investigation of skin pathology. J Eur Acad Dermatol Venereol 2010; 25:375-82. [PMID: 20849441 DOI: 10.1111/j.1468-3083.2010.03837.x] [Citation(s) in RCA: 110] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Ultrasonography is a valuable diagnostic tool widely used in medicine. During the last three decades, this non-invasive skin imaging method has been extended to dermatology. High-frequency ultrasonography with higher than 20MHz scanners is well-established for measuring tumour thickness and skin thickness when treating inflammatory skin diseases such as scleroderma or psoriasis. High-frequency ultrasonography has become extremely helpful for the preoperative assessment of skin melanoma. The correlation between ultrasonic and histological measurements of melanomas thickness is significantly similarly good using transducers of 20, 75 or 100MHz frequency (r range from 0.895 to 0.99) and better compared with transducers of 7.5MHz frequency (r=0.76). The preoperative sonographically estimated thickness of skin melanoma is sometimes overestimated, because of an underlying inflammatory infiltrate and other reasons. Assessment of skin melanoma thickness using transducers of 100MHz frequency has better agreement with histology, compared with ultrasonography with 20MHz transducers. However, the ultrasonic penetration depth is limited to 1.5mm in case of 100MHz. The newer ultrasonic techniques such as high-frequency ultrasonography and colour Doppler sonography could be used for assessment of the tumour vascularization and its metastatic potential. The wide variety of diagnostic information provided by high-frequency ultrasonography undoubtedly improves the management of oncological and inflammatory skin conditions and underlines its essential position in dermatological practice.
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Affiliation(s)
- D Jasaitiene
- Department of Skin and Venereal Diseases of Kaunas University of Medicine, Kaunas Ultrasound Institute, Kaunas University of Technology, Kaunas, Lithuania.
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Wang SQ, Hashemi P. Noninvasive Imaging Technologies in the Diagnosis of Melanoma. ACTA ACUST UNITED AC 2010; 29:174-84. [DOI: 10.1016/j.sder.2010.06.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Samimi M, Perrinaud A, Naouri M, Maruani A, Perrodeau E, Vaillant L, Machet L. High-resolution ultrasonography assists the differential diagnosis of blue naevi and cutaneous metastases of melanoma. Br J Dermatol 2010; 163:550-6. [PMID: 20545694 DOI: 10.1111/j.1365-2133.2010.09903.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Metastases of cutaneous melanoma may simulate benign blue naevi clinically. OBJECTIVES To investigate the value of ultrasonography in the differential diagnosis of lesions that look similar clinically, i.e. blue naevi and cutaneous metastases of melanoma. METHODS Participants were invited for inclusion in the study if they had a cutaneous blue lesion clinically suggestive of a blue naevus or cutaneous metastasis of melanoma. After obtaining signed consent, the lesion was photographed and studied using dermoscopy and high-resolution ultrasonography before being removed for histological examination. Clinical, dermoscopic and ultrasonographic images were reviewed anonymously by four dermatologists to assign the diagnosis of blue naevus or metastasis of melanoma. The diagnostic performance of clinical examination, dermoscopy and sonography was assessed for the ability of each to differentiate between metastases of melanoma and blue naevi with reference to the histological diagnosis. Moreover, experts undertook a semeiological description of each ultrasonographic image according to seven items: location of the lesion, echogenicity, homogeneity, shape of the lesion, definition of margins, posterior acoustic shadow and increased posterior echogenicity. RESULTS Twenty-eight patients were included with a total of 39 blue skin lesions, and 17 of the 28 patients had a previous history of melanoma. Interobserver agreement in the semeiological description of the sonographic images was good (κ≥0·6) for five of seven items. Sonography was more specific (94%) than clinical examination (77%) and dermoscopy (74%). The sonographic features contributing to the differential diagnosis were: location of the lesion (P=0·027), shape of the lesion (P<0·001), homogeneity (P=0·001) and increased posterior echogenicity (P=0·007). CONCLUSIONS Ultrasonography is a reproducible and specific tool that can assist the differential diagnosis between blue naevi and metastases of melanoma. A blue naevus is a homogeneous, hypoechoic, 'dish-shaped' lesion, located in the superficial dermis, whereas metastases of melanoma are 'potato-shaped', hypoechoic, heterogeneous lesions, located in the hypodermis.
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Affiliation(s)
- M Samimi
- Université François Rabelais, Tours, France.
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Music MM, Hertl K, Kadivec M, Pavlović MD, Hocevar M. Pre-operative ultrasound with a 12-15 MHz linear probe reliably differentiates between melanoma thicker and thinner than 1 mm. J Eur Acad Dermatol Venereol 2010; 24:1105-8. [PMID: 20236207 DOI: 10.1111/j.1468-3083.2010.03587.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Pre-operative determination of primary melanoma thickness could be a tool to identify those patients who could be treated with radical primary tumour excision and sentinel lymph node biopsy in a single procedure. An excellent correlation between sonographic and histological measurement of maximal tumour thickness has been achieved using 20-MHz transducers. OBJECTIVE To show that widely available high resolution ultrasound with 12-15 MHz linear probe could also reliably assess the thickness of primary melanoma. METHODS Sixty-nine patients underwent ultrasound evaluation of 70 clinically and dermoscopically suspicious pigmented skin lesions before surgical excision. RESULTS The sensitivity, specificity, positive and negative predictive values of ultrasound to detect melanoma > 1 mm were 92%, 92%, 95% and 81% respectively. The correlation between ultrasound and histological tumour thickness was very good [Pearson's correlating index 0.823 (P < 0.001)]. Mean difference between sonographic and histological measurements was 0.045 mm with limits of agreement estimated at -1.4 and +1.49, and a bias between two methods 45 microm. CONCLUSION Ultrasound examination with a 12-15 MHz linear transducer can reliably differentiate primary melanoma > 1 mm from those <or= 1 mm.
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Affiliation(s)
- M M Music
- Department of Radiology, Institute of Oncology, Ljubljana, Slovenia
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High-frequency 30-MHz sonography in preoperative assessment of tumor thickness of primary melanoma: usefulness in determination of surgical margin and indication for sentinel lymph node biopsy. Int J Clin Oncol 2009; 14:426-30. [DOI: 10.1007/s10147-009-0894-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2008] [Accepted: 03/11/2009] [Indexed: 10/20/2022]
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Preoperative assessment of cutaneous melanoma thickness using 10-MHz sonography. AJR Am J Roentgenol 2009; 193:639-43. [PMID: 19696275 DOI: 10.2214/ajr.08.1387] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate the prognostic value of 10-MHz sonography in measuring melanoma thickness before biopsy or excision. SUBJECTS AND METHODS Fifty-four patients with lesions suggestive of melanoma participated in the study. Lesions were measured on sonography using a 10-MHz linear transducer before routine biopsy and histopathologic analysis. Sonographic measurements were compared with histopathologic results (Breslow index) using Pearson's correlation coefficient and concordance analysis. Additional statistical analyses included sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of 10-MHz sonography in identifying lesions > 1 mm thick. RESULTS Histopathologic analysis identified all 54 lesions as melanoma. On sonography, 34 lesions measured < or = 1 mm and 20 lesions, > 1 mm. Histopathologic analysis showed 32 lesions with a Breslow index of < or = 1 mm and 22 lesions with a Breslow index of > 1 mm. The median thickness of the 54 lesions was 1.33 mm (range, 0-5 mm) by the Breslow index compared with 1.85 mm (range, 0-4.8 mm) by sonography. Comparison of sonographic measurements and Breslow index values gave a correlation coefficient of 0.93 and a concordance coefficient of 0.99. Overall, sonographic measurements showed 86% sensitivity, 97% specificity, 93% accuracy, 95% positive predictive value, and 91% negative predictive value in identifying lesions with a Breslow index of > 1 mm. CONCLUSION In our series of 54 melanomas, 10-MHz sonography measured lesion thickness with good accuracy compared with histopathology. Sonography was effective in discriminating between tumors < or = 1 mm thick and those > 1 mm thick.
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Machet L, Belot V, Naouri M, Boka M, Mourtada Y, Giraudeau B, Laure B, Perrinaud A, Machet MC, Vaillant L. Preoperative measurement of thickness of cutaneous melanoma using high-resolution 20 MHz ultrasound imaging: A monocenter prospective study and systematic review of the literature. ULTRASOUND IN MEDICINE & BIOLOGY 2009; 35:1411-1420. [PMID: 19616369 DOI: 10.1016/j.ultrasmedbio.2009.03.018] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2008] [Revised: 03/06/2009] [Accepted: 03/19/2009] [Indexed: 05/28/2023]
Abstract
Histologic measurement of the thickness of melanoma is a major prognostic factor and governs the size of the surgical excision (1cm for melanomas less than 1 mm thick, 2 cm for melanomas thicker than 2 mm and 3 cm beyond 4 mm). To determine whether high-resolution ultrasound can be used to predict surgical margins and, thus, to operate on patients in a single procedure avoiding further re-excision, we performed a systematic review of studies published from January 1987 to June 2007 and a prospective study. The systematic review selected 14 studies comparing histologic and ultrasound measurements and showing correlation coefficients generally greater than 0.9. Data available from 7 of the 14 studies (total 869 patients) showed predictive values of adequate margins in at least 72% of lesions using preoperative measurement of ultrasound thickness. The prospective study included 31 patients referred with a primary melanoma from March 2005 to March 2007. Ultrasound measurement of thickness was possible except for thin melanomas (<0.4 mm) in areas with marked photoaging, in the plantar zone, and in the case of very thick melanomas exceeding the explored depth (7.6 mm). The average thickness was 1.96 mm measured by ultrasound (SD: 2.15) and 1.95 mm by histology (SD: 2.62) and the Bland and Altman graph showed moderate agreement between ultrasound and histology. Limits of agreement were estimated at -1.4 and +1.8, corresponding to relative limits of agreement of -40 to +80%. Ultrasound predicted appropriate margins (1, 2 or 3 cm wide according to sonometric thickness) in 26 of the 31 subjects (84%, 95% CI 66-95). Preoperative high-resolution ultrasound is a noninvasive examination that can help in choosing appropriate surgical margins and should reduce the need of partial or excisional biopsy before surgery, and the need for further re-excision.
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Affiliation(s)
- Laurent Machet
- Université Francois Rabelais de Tours, UMR INSERM U CNRS ERL, France.
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Guitera P, Li L, Crotty K, FitzGerald P, Mellenbergh R, Pellacani G, Menzies S. Melanoma histological Breslow thickness predicted by 75-MHz ultrasonography. Br J Dermatol 2008; 159:364-9. [DOI: 10.1111/j.1365-2133.2008.08681.x] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Preoperative Ultrasonic Assessment of Thin Melanocytic Skin Lesions Using a 100-MHz Ultrasound Transducer. Dermatol Surg 2007. [DOI: 10.1097/00042728-200707000-00006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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26
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Gambichler T, Moussa G, Bahrenberg K, Vogt M, Ermert H, Weyhe D, Altmeyer P, Hoffmann K. Preoperative Ultrasonic Assessment of Thin Melanocytic Skin Lesions Using a 100-MHz Ultrasound Transducer: A Comparative Study. Dermatol Surg 2007; 33:818-24. [PMID: 17598847 DOI: 10.1111/j.1524-4725.2007.33175.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND It has been shown that tumor thickness (TT) of melanocytic skin lesions (MSL) of less than 1 mm vertical thickness assessed by 20 MHz are often incorrectly evaluated. OBJECTIVE We aimed to evaluate the accuracy of 100-MHz ultrasound for the determination of TT of thin MSL, compared with conventional 20-MHz ultrasound and histologic findings. METHODS Thirty-seven patients with 50 suspicious MSL, including tumor diameter up to 1 cm and maximum vertical TT of less than 1 mm, were recruited. The agreement between the histologically and ultrasographically measured TT was analyzed using Bland and Altman plots. RESULTS Compared to histology, 20-MHz ultrasound (33.9 microm) as well as 100-MHz (16 microm) resulted in overestimation of TT that was twofold higher for 20-MHz ultrasound. The latter also revealed wider 95% limits of agreement (4.9 to 63 microm) than 100-MHz ultrasound (3.5 to 28.7 microm). CONCLUSION Analysis of agreement clearly demonstrated that the performance of 100-MHz ultrasound is superior to conventional 20-MHz ultrasound, even though a relatively small positive bias was observed in 100-MHz ultrasound, indicating a systematic error. We consider 100-MHz ultrasound a useful tool for the noninvasive determination of TT of thin MSL in vivo.
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Affiliation(s)
- Thilo Gambichler
- Department of Dermatology, Ruhr-University Bochum, Bochum, Germany.
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Lassau N, Lamuraglia M, Koscielny S, Spatz A, Roche A, Leclere J, Avril MF. 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 Imaging 2006; 6:24-9. [PMID: 16644502 PMCID: PMC1693780 DOI: 10.1102/1470-7330.2006.0009] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To study the value of high-frequency sonography (HFS) and colour Doppler sonography (CDS) in evaluating the 5 year metastatic potential of primary cutaneous melanomas (CM). MATERIALS AND METHODS 111 CM were studied before surgical resection and 107 were depicted on HFS. The maximal HFS thickness was measured and compared with the Breslow thickness. A CDS study was performed in each tumour. RESULTS HFS thickness ranged from 0.26 to 8.0 mm and Breslow thickness from 0.15 to 8.0 mm. HFS and Breslow thickness correlated strongly (r > 0.93). Intratumour vessels were depicted in 43 of the 107 CM, of which 40 were thicker than 2 mm. The median follow-up was 61 months and 27 patients developed relapses. In the univariate analyses, neovascularization visualized with CDS, sonographic thickness and the Breslow thickness were significantly linked to relapses (p < 0.0001), as were lymph node status and ulceration (p = 0.007 and 0.004). CONCLUSION Vascularization was observed mainly in thick primary melanoma. A median follow-up of 5 years showed the prognostic value of angiogenesis evaluated by CDS.
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Affiliation(s)
- Nathalie Lassau
- Department of Medical Imaging, Institut Gustave Roussy, 39 rue Camille Desmoulins, 94805 Villejuif, France
| | - Michele Lamuraglia
- Department of Medical Imaging, Institut Gustave Roussy, 39 rue Camille Desmoulins, 94805 Villejuif, France
- Department of Biostatistics, Institut Gustave Roussy, 39 rue Camille Desmoulins, 94805 Villejuif, France
- Section of Internal Medicine, Departments of Internal Medicine and Public Medicine, University of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Serge Koscielny
- Department of Biostatistics, Institut Gustave Roussy, 39 rue Camille Desmoulins, 94805 Villejuif, France
| | - Alain Spatz
- Department of Pathology, Institut Gustave Roussy, 39 rue Camille Desmoulins, 94805 Villejuif, France
| | - Alain Roche
- Department of Medical Imaging, Institut Gustave Roussy, 39 rue Camille Desmoulins, 94805 Villejuif, France
| | - Jerome Leclere
- Department of Medical Imaging, Institut Gustave Roussy, 39 rue Camille Desmoulins, 94805 Villejuif, France
| | - Marie-Françoise Avril
- Department of Dermatology, Institut Gustave Roussy, 39 rue Camille Desmoulins, 94805 Villejuif, France
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Noninvasive Imaging of Skin Tumors. Dermatol Surg 2004. [DOI: 10.1097/00042728-200402002-00012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
In this article, the authors review different approaches to the diagnosis of skin tumors using noninvasive diagnostic tools, which are becoming increasingly reliable and, as a consequence, increasingly popular among physicians and patients. Especially in the realm of pigmented skin lesions, dermoscopy and sonography may add useful information to the clinical constellation, improving the diagnostic performance for early diagnosis of melanoma and for differentiating various melanocytic and nonmelanocytic pigmented lesions. More recently, confocal scanning laser microscopy was introduced as a novel technique that enables the in vivo study of the skin at a nearly histologic resolution, being of diagnostic value in various skin disorders, including basal cell carcinoma and pigmented skin lesions. These modalities have various other potential applications besides diagnosis, including lesion's selection for biopsy, determination of appropriate therapeutic modalities, verification of treatment efficacy, and decision of surgical margins. Finally, a hint to the use of cytodiagnosis for basal cell carcinoma is provided.
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Affiliation(s)
- Eleonora Ruocco
- Department of Dermatology, Second University of Naples, Naples Department of Dermatology, University of Modena, Modena, Italy
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Van den Kerckhove E, Staes F, Flour M, Stappaerts K, Boeckx W. Reproducibility of repeated measurements on post-burn scars with Dermascan C. Skin Res Technol 2003; 9:81-4. [PMID: 12535289 DOI: 10.1034/j.1600-0846.2003.00375.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The present study investigated the reproducibility of measurements with the Dermascan C on post-burn scars. Intra- and inter-rater reproducibility and test-retest reliability with a one week time lapse were examined on 40 post-burn scars of 6 volunteering burn patients by means of intra-class- correlation coefficients (ICC) and standard error of measurements (SEM). Results showed good to excellent values for ICC in all the three conditions. On the basis of these results, we concluded that the instrument provides reliable information and can be used in comparative clinical trials that examine therapeutic strategies on healing scars.
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Affiliation(s)
- Eric Van den Kerckhove
- Department of Physical Medicine and Rehabilitation, Burn Center of the University Hospital of Leuven, Belgium.
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Abstract
This article presents a snapshot of fast-moving research into the application of digital imaging technology to in vivo computer-aided diagnosis of early melanoma. It is written from the perspective of a researcher with a keen interest in bringing this technology to physicians' offices. The primary emphasis is on reviewing the existing literature, supplemented by unpublished material relating to a particular system and as yet unpublished research studies.
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Affiliation(s)
- Marek Elbaum
- Electro-Optical Sciences, Inc., 1 Bridge Street, Suite 15, Irvington, NY 10533, USA.
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Serrone L, Solivetti FM, Thorel MF, Eibenschutz L, Donati P, Catricalà C. High frequency ultrasound in the preoperative staging of primary melanoma: a statistical analysis. Melanoma Res 2002; 12:287-90. [PMID: 12140386 DOI: 10.1097/00008390-200206000-00013] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
High frequency sonography has been shown to be a useful tool in the preoperative staging of malignant melanoma. In the present study sonometric and histometric data concerning tumour thickness were compared, using appropriate statistical methods, in order to assess the accuracy of ultrasonography. From December 1997 all pigmented lesions suspected of being melanoma were preoperatively assessed by a 20 MHz ultrasound B scan. The results of these ultrasound examinations were compared with histometric data. Pearson's correlation coefficient and absolute and relative differences were used for statistical analysis. Of the 261 examined lesions, 193 were malignant melanoma. A high correlation between sonometry and histometry was computed (r = 0.95), with an absolute difference of 0.32 +/- 0.03 mm (mean +/- SEM) and a mean relative difference of 27.2% (95% confidence interval 23-31.4%). The highest correlation was found in melanoma > or = 1.51 mm thick and the lowest correlation in melanoma < or = 0.75 mm. In conclusion, the high accuracy of this technique in the preoperative staging of malignant melanoma would offer a basis for defining the surgical margins of > or = 0.76 mm thick lesions. The limited accuracy of sonometry in the preoperative staging of thin melanoma < or = 0.75 mm has emerged by applying adequate statistical methods.
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Affiliation(s)
- L Serrone
- Regina Elena Institute, Division of Medical Oncology A, via Elio Chianesi, 53-00128, Rome, Italy.
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34
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Weichenthal M, Mohr P, Breitbart EW. The velocity of ultrasound in human primary melanoma tissue - implications for the clinical use of high resolution sonography. BMC DERMATOLOGY 2001; 1:1. [PMID: 11445001 PMCID: PMC34515 DOI: 10.1186/1471-5945-1-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2001] [Accepted: 06/28/2001] [Indexed: 11/10/2022]
Abstract
BACKGROUND Ultrasonography with 20 MHz frequency can be used to estimate tumour thickness preoperatively in malignant melanoma (MM) of the skin. The vertical invasion depth is the single most important prognostic factor for localised MM, and its preoperative knowledge would be very useful for the planning of surgical procedures. Since ultrasonographic distance measurements directly depend upon the tissue specific ultrasound velocity, we determined the ultrasound velocity in primary melanoma. RESULTS Ultrasound velocity was calculated from runtime differences of a 20 MHz ultrasound signal along a known distance either through water alone or through thick specimens of primary MM. The ultrasound velocities varied between 1553 m/s and 1588 m/s with a mean of 1564 m/s in four different MM specimens. The analysis of different parts of the specimens showed that the variation of the calculated velocities was larger between different specimens than within one individual specimen. CONCLUSIONS The ultrasound velocity in MM tissue may be slightly lower than normally assumed, thereby explaining a part of the overestimation usually found in sonographic measurement of melanoma invasion depth. Additionally, the variation of ultrasound velocity between individual tumours may contribute to the impairment of the correlation found between sonometry and Breslow's measurement of MM invasion depth. For practical reasons, a setting of 1580 m/s will be appropriate for ultrasonography of primary malignant melanoma.
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Affiliation(s)
- Michael Weichenthal
- Department of Dermatology, St.Georg Hospital, Lohmuhlenstr.5, D-20099 Hamburg, Germany
| | - Peter Mohr
- Department of Dermatology, Buxtehude Hospital, Buxtehude, Germany
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Stante M, De Giorgi V, Cappugi P, Giannotti B, Carli P. Non-invasive analysis of melanoma thickness by means of dermoscopy: a retrospective study. Melanoma Res 2001; 11:147-52. [PMID: 11333124 DOI: 10.1097/00008390-200104000-00009] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Epiluminescence microscopy (ELM), or dermatoscopy, is a non-invasive technique for the diagnosis of cutaneous melanoma that may play a role in the non-invasive, preoperative assessment of melanoma thickness. This study investigated the correlation between the frequency of appearance of some standard ELM criteria and the histological thickness of melanomas. In addition, the possible role of the total dermoscopic score (TDS) according to ABCD rule of dermoscopy as a predictor of melanoma thickness was analysed. The dermoscopic images of 84 cutaneous melanomas were retrospectively investigated to evaluate the presence of 10 standard ELM criteria, and for each lesion the TDS was established (with observers blinded as to the tumour thickness). A statistically significant association was found between the presence of an irregular pigment network and melanomas with a Breslow index equal to or lower than 0.75 mm (positive predictive value of 68%); in contrast, radial streaming, atypical vascular pattern and grey-blue areas were associated with melanomas > 0.75 mm (positive predictive values of 77%, 65% and 70%, respectively). Of the melanomas thinner than 0.76 mm, 82% showed a TDS lower than 6.80 (optimized cut-off point), while 79% of melanomas thicker than 0.75 mm had a TDS higher than 6.80 (chi2 = 30.815, P < 0.001); the positive predictive value of a TDS > 6.80 in the detection of lesions thicker than 0.75 mm was 79%. In conclusion, a statistically significant correlation does exist between some dermoscopic features and melanoma thickness. Both the mostly used dermoscopic methods (standard ELM pattern analysis and the ABCD rule of dermatoscopy) may provide useful information in the non-invasive assessment of melanoma thickness. However, their diagnostic performance is far from 100%; further studies are needed to investigate whether the combination of dermoscopy with other non-invasive approaches (e.g. sonometry) may result in an overall improvement in the diagnostic performance.
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Affiliation(s)
- M Stante
- Department of Dermatology, University of Florence, Italy
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Carli P, de Giorgi V, Palli D, Giannotti V, Giannotti B. Preoperative assessment of melanoma thickness by ABCD score of dermatoscopy. J Am Acad Dermatol 2000; 43:459-66. [PMID: 10954657 DOI: 10.1067/mjd.2000.106518] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Epiluminescence microscopy is a useful tool for the noninvasive diagnosis of malignant melanoma based on criteria that have been correlated with specific histologic characteristics. Previous studies have also shown a good correlation between the frequency of some dermatoscopic criteria based on pattern analysis (pigment network, blue-gray areas, vascular pattern) and tumor thickness. This technique could be useful in the preoperative assessment of tumor thickness as an indication for sentinel node biopsy. OBJECTIVE Our purpose was to evaluate the possible role of the total dermatoscopy score (TDS) assigned to a series of lesions in accordance with the ABCD rule of dermatoscopy as a preoperative predictor of melanoma thickness. METHODS For 84 cutaneous melanomas (17 were in situ melanomas; 67 invasive cases with mean thickness 0. 93 mm; range, 0.2-3.9 mm; standard deviation, 0.63) consecutively excised at the Department of Dermatology of Florence, TDS was established by two observers blinded as to the tumor thickness. The performance of different cut-off points of TDS in the diagnosis of melanoma with Breslow's thickness more than 0.75 or 1.00 mm was investigated by receiver operating characteristic (ROC) analysis. Accuracy of classification was evaluated in terms of sensitivity, specificity, and area under ROC curves (AUC). RESULTS The TDS assigned to cutaneous melanomas by the ABCD rule increased with the thickness of the lesions from in situ melanomas to melanomas of intermediate thickness (0.75-1.50 mm). As a preoperative method for the detection of melanomas with a Breslow thickness greater than 0. 75 mm, a TDS cut-off point of 6.80 showed 80% sensitivity, 84% specificity, and 82% diagnostic accuracy (AUC value, 0.90). TDS performed better in the diagnosis of a thickness threshold of 0.75 than 1.00 mm (higher AUC value). CONCLUSION The TDS calculated by the ABCD rule of dermatoscopy-a simplified approach to dermatoscopic diagnosis of melanoma-provides useful information for the preoperative assessment of melanoma thickness greater than 0.75 mm.
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Affiliation(s)
- P Carli
- Department of Dermatology, University of Florence, S Maria Annunziata Hospital, Florence, Italy.
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Krähn G, Gottlöber P, Sander C, Peter RU. Dermatoscopy and high frequency sonography: two useful non-invasive methods to increase preoperative diagnostic accuracy in pigmented skin lesions. PIGMENT CELL RESEARCH 1998; 11:151-4. [PMID: 9730322 DOI: 10.1111/j.1600-0749.1998.tb00725.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Dermatoscopy and high frequency sonography have recently been combined to increase diagnostic preoperative accuracy in the treatment of pigmented skin lesions. In this monocentric study 80 patients with pigmented skin lesions were evaluated clinically, by dermatoscopy, and 20 MHz-sonography followed by dermatohistopathological evaluation; 39 malignant melanomas, 37 common nevi, 3 dysplastic nevi, and 1 nevus Spitz were diagnosed histologically. In 72 of the 80 cases (91.3%) dermatoscopical diagnoses were confirmed by histopathology, compared to only 79% correct clinical diagnoses. For the mere clinical diagnosis of melanoma sensitivity was 79%, specificity was 78% and diagnostic accuracy was 65%. All diagnostic values increased by dermatoscopy: sensitivity reached 90%, specificity was 93%, and diagnostic accuracy was 83%. In order to determine tumor thickness preoperatively tumor thickness was measured by 20 MHz sonography. The correlation of tumor thickness between histometric and sonographic results was determined for nevi (r = 0.93) and melanoma (r = 0.95); 74.3% of melanomas were diagnosed correctly within an 0.2 mm range. Regarding the clinical important limit of 1 mm tumor thickness, 87.2% were diagnosed in accordance with histometric evaluation. An increase of 18% in diagnostic accuracy by dermatoscopy and 87.2% of correctly diagnosed cases of tumor thickness of malignant melanoma by high frequency sonography clearly demonstrate that these methods should be considered standard procedures in the diagnosis of pigmented skin lesions and will facilitate the decision on necessary surgical treatment.
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Affiliation(s)
- G Krähn
- Department of Dermatology, University of Ulm, Germany
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Abstract
BACKGROUND Although cryosurgical methods have high cure rates, imprecise estimates of both skin lesion depth and destructive temperature front location result in subjective technique in skin malignancy treatments. OBJECTIVE We evaluated the possibility of newer ultrasound equipment to assist in the precise placement of thermocouples in human skin. METHODS DermaScan C ver. 3 ultrasonographic equipment fitted with a sharp focus probe with a frequency of 20 MHz and a scan length of 12.1 mm was used to locate thermocouples with 27- and 30-gauge needles. RESULTS We successfully and reproducibly located thermocouples and thin needles, and accurately measured their distance from the skin surface. CONCLUSION Ultrasound is a useful method for the accurate placement of thermocouples, and needles as thin as 30 gauge for monitoring in cryosurgery.
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Affiliation(s)
- W Abramovits
- Department of Dermatology, McAllen Branch, University of Texas School of Medicine, San Antonio, USA
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