High-Frequency Ultrasound Assessment of Skin and Oral Mucosa in Metabolic Syndrome Patients-A Cross-Sectional Study

Background: Exogenous factors (such as sun exposure, smoking habits, and diet) and endogenous (inflammatory status, general diseases) have a direct influence on skin and soft tissue characteristics. The study’s objective was to assess the impact of metabolic syndrome (MS) on characteristics of skin layers in sun-exposed and non-exposed maxillofacial tissues evaluated by high-frequency ultrasound (HFU), as a potential diagnosis and monitoring tool for the aging process. Material and methods: The present study included 102 subjects (24 with MS; 78 without MS). Anthropometric parameters and disease history were recorded, and blood samples were harvested in order to assess biochemical parameters of MS. Sun-exposed skin (zygomatic region) and non-exposed oral mucosa of the lower lip were assessed using HFU (DUB^® cutis, Taberna Pro Medicum) with a 22 MHz probe. Results: Patients with cardiac disease had significantly lower values for epidermis density (p = 0.002). Gender was independently linked to the aged dermis depth (p < 0.001), aged dermis no. of px (pixels) (p < 0.001), dermis depth (p < 0.001), dermis no. of px (p < 0.001), and subcutaneous tissue density (p < 0.001). Patients with MS had thinner epidermis (p = 0.008) and thinner aged dermis (p = 0.037) when compared to non-MS subjects. Conclusion: Patients with MS had thinner epidermis and a lower epidermis number of pixels in sun-exposed skin. Women had lower epidermis density and thicker dermis in sun-exposed skin. Our study showed that HFU, as a non-invasive investigation approach, is useful to diagnose and monitor the aging process in skin and oral mucosa, correlated with skin phenotype pathological conditions.

Nevus sebaceus of Jadassohn - high frequency ultrasound imaging and videodermoscopy examination. Case presentation

Nevus sebaceus of Jadassohn (NSJ) is a congenital cutaneous hamartoma mainly developing from pilosebaceous unit cells. NSJ has the potential to develop into a variety of benign and malignant tumors, which are not limited to sebaceous differentiation. The dynamical monitoring for the earliest malignant transformation is necessary. Herein, we report the combined noninvasive NSJ examination with videodermoscopy in polarized and non-polarized light and high-frequency ultrasound (HFUS) imaging at 33 and 50 MHz. Typical NSJ dermoscopic signs where described, the internal nevus structure and its location, depths, and margins with surrounded tissues were examined with high-frequency ultrasound.

Some HFUS characteristics for NSJ were described. Videodermoscopy and high-frequency ultrasound combined examination could be useful for NSJ dynamical monitoring in order to detect malignant transformation and to define necessary and sufficient tissue excision volume in case of surgical treatment.

Basal cell carcinoma invasion depth determined with 30 and 75 MHz high-frequency ultrasound and histopathology - a comparative study

AIM

To compare the depth spread of basal cell carcinoma (BCC) measured by histological examination and high-frequency ultrasound (HFUS) imaging with 30-MHz and 75-MHz probes.

MATERIALS AND METHODS

HFUS skin imaging was used to examine 27 BCCs. A specialized high-resolution digital ultrasound imaging system DUB (TPM GmbH, Germany) with 75-MHz and 30-MHz probes was used. After HFUS scanning, the BCCs biopsy samples were collected by punch biopsy or surgical excision for the morphological examination. Based on the histomorphology results obtained, the tumors were divided into thin (≤1 mm invasion depth) and thick (>1 mm invasion depth). Each BCC spread depth was measured during the HFUS examination with 75-MHz and 30-MHz ultrasound probes and morphological examination.

RESULTS

Thin BCCs average invasiondepth measured histologically was 0.494±0.212 mm. Its average depth obtained with HFU examination with 75-MHz and 30-MHz probes was 0.591±0.265 and 0.734±0.123 mm, respectively. High, statistically significant correlation betweenthe histological and 75 MHz HFU measurements was obtained (r=0.870). The correlation was weak (r=0.290) when using a 30 MHz transducer. The average thick BCC invasion depth values obtained with the histological examination and 30 MHz HFUS scanning was 1.845±0.718 mm and 1.995±0.699 mm, respectively. High, statistically significant (r=0.951) correlation between the thick BCC spread depth measured with 30 MHz transducer and histomorphological examination was obtained.

CONCLUSIONS

In cases of BCCs with thickness of ≤1 mm, there was a high correlation (r=0.870) of the tumor spread depth between micromorphological measurements and the results obtained using a 75 MHz transducer and in cases of BCCs with thickness of >1 mm, a very high correlation (r=0.951) of the tumor spread depth was observed between histomorphometry and30 MHz transducer measurements.

Current Role of Radiotherapy in Non-melanoma Skin Cancer

Non-melanoma skin cancer (NMSC) represents the most frequently diagnosed malignancy worldwide, most being cutaneous basal cell and squamous cell carcinoma. The global incidence of NMSC continues to increase as the global population ages. Numerous treatment options are available for NMSC patients, with radiotherapy an efficacious and tissue-preserving non-surgical option. External beam radiotherapy and brachytherapy are modalities with specific indications and advantages in treating NMSC. Where excision is not an option (medically/technically inoperable) or considered less ideal (e.g. cosmetic or functional outcome), radiotherapy offers an excellent alternative. Inoperable elderly and/or co-morbid patients of poor performance status can benefit from short-course hypofractionated radiotherapy, with very acceptable toxicity. Adjuvant radiotherapy in patients with unfavourable pathology can decrease the risk of local and regional recurrence and associated morbidity and mortality. Radiotherapy has advantages and disadvantages and it is important for clinicians to understand these. Managing patients with NMSC is carried out by clinicians from multiple disciplines but it is imperative that they are all aware of the role of radiotherapy in their patients in various clinical settings. Here we aim to discuss the role and indications for recommending radiotherapy in patients with NMSC.

Ultrasonographic features of superficial and nodular basal cell carcinoma

AIM

To describe the ultrasonographic findings of surface and nodular basal cell skin cancer (BCC) using high frequency ultrasonography.

MATERIALS AND METHODS

We examined 60 primary BCCs in different locations with the High Frequency Ultrasound (HFU) system DUB Skin Scanner using 75 MHz and 30 MHz probes. Epidermis, dermis, and depth of tumors spread in the region of interest (ROI) were measured. Visually unchanged, contralateral skin areas were examined as the control. Results: The surface BCC most often had elongated contours, clear margins and hypoechoic structure, while the nodular BCC had round or oval outlines and diffusely hypo-heterogeneous structure with clear margins. Sclerodermiform BCCs were visualized as hypoechoic areas of irregular shape penetrating in the dermis, with wavy fuzzy margins. The average thickness of the surface BCC in the US examination was 556.28±136.95 μ, the nodular BCC thickness was 2439.71±865.92 μ and the sclerodermiform thickness was 1500±325.33 μ. A statistically significant increase in the average thickness of tumors of the nodularand scleroderma forms was observed in comparison with the surface clinical variant (p<0.05). Hyperechoic inclusions were observed in 11% of the surface BCC's and in the 100% of the nodular BCC's. Their average number was 2±0.57 and 4±4.8, with the average area of 0.03±0.02 mm2 and 0.04±0.03 mm2 (p>0.05), respectively. In the surface BCC, they were mainly located along the periphery of the hypoechoic zones. In nodular BCC, the inclusions had a peripheral and combined (center and peripheral) distribution.

CONCLUSIONS

Ultrasound allows differentiating BCC as diffuse-heterogeneous, hypoechoic, formations in the dermis with distinct contours. Depending on the clinical picture, they differ in form, depth of bedding, as well as in the quantitative ratio and distribution of the point hyperechoic structures in them.

High frequency ultrasound study of skin tumors in dermatological and aesthetic practice

The accurate measurement of skin tumors and the precise delimitation of its borders are important tools for tumor diagnosis and treatment. In this paper we summarized our practical experience in `the examination of different skin tumors using high frequency ultrasound (HFU). High-frequency transducers 22 MHz and 75 MHz with resolution of 72 and 21 μm were used for the examination. HFU characteristics of the most important non-melanoma skin tumors are depicted.