Differential Diagnosis of Malignant Melanoma and Benign Cutaneous Lesions by Ultrasound Analysis

Michael Hambardzumyan, A. Hayrapetyan

Abstract


Background:  The purpose of the study is to evaluate the assessment of ultrasound analysis in the differential diagnosis of skin melanoma and benign cutaneous lesions. Objective: 61 patients (23 men and 38 women) between 17 and 87 years of age, with melanomas, atheromas, hemangiomas, keratoses, and naevi were studied. Methods: High-frequency gray-scale ultrasound analysis, color Doppler, power Doppler, advanced dynamic flow, strain Elastography, digital Dermoscopy were performed in all cases. Results: In malignant melanoma cases we have mainly: sharp margins, hypoechoic, homogenous structure, absent of posterior shadowing, central and disorganized circulatory pattern with multiple peduncles. In some benign pathology, several ultrasound criteria were exclusive: microcalcifications are only in atheroma, posterior shadowing, and circular rim - in keratosis. The incidence of other ultrasound criteria can vary in atheroma, hemangioma, keratosis, and nevus. Tumor longitudinal and thickness relation were higher (7.9±1.96) than in all benign pathologies (2.1-4.8). The Elastography stiffness of the 26 skin melanomas was 2.95±0.18 and was higher than the group of 35 patients with all benign skin pathology (0.96±0.59), including atheroma (2.0±0.78), hemangioma (0.55±0.21), keratosis (1.21±0.21) and nevus (0.78±0.45). Conclusion: Multimodal approaches to exploring high-frequency ultrasound analytic criteria can be helpful in the differential diagnosis of malignant melanoma and benign cutaneous lesions.


Keywords


Differential Diagnosis; Melanoma; Atheroma; Hemangioma; Keratosis; Nevus; Dermoscopy; Ultrasound Criteria; Color Doppler (CD); Power Doppler (PD); Advanced Dynamic Flow (ADF); Longitudinal and Thickness (L/T) Relation; Elastography.

References


Rigel, D. S., Russak, J., & Friedman, R. (2010). The Evolution of Melanoma Diagnosis: 25 Years Beyond the ABCDs. CA: A Cancer Journal for Clinicians, 60(5), 301–316. doi:10.3322/caac.20074.

Leachman, S. A., Cassidy, P. B., Chen, S. C., Curiel, C., Geller, A., Gareau, D., … Weinstock, M. A. (2015). Methods of Melanoma Detection. Cancer Treatment and Research, 51–105. doi:10.1007/978-3-319-22539-5_3.

Van der Leest, R. J. T., de Vries, E., Bulliard, J.-L., Paoli, J., Peris, K., Stratigos, A. J., … del Marmol, V. (2011). The Euromelanoma skin cancer prevention campaign in Europe: characteristics and results of 2009 and 2010. Journal of the European Academy of Dermatology and Venereology, 25(12), 1455–1465. doi:10.1111/j.1468-3083.2011.04228.x.

Partsch, H. (1982). Measuring methods in dermatological angiology (author's transl). Zeitschrift fur Hautkrankheiten, 57(4), 227-246.

Strasser, W., Vanscheidt, W., Hagedorn, M., & Wokalek, H. (1986). B-scan ultrasound in dermatology. Fortschritte der Medizin, 104(25), 495.

Wortsman, X. (2012). Common Applications of Dermatologic Sonography. Journal of Ultrasound in Medicine, 31(1), 97–111. doi:10.7863/jum.2012.31.1.97.

Schroeder, R. J., Maeurer, J., Vogl, T. J., Hidajat, N., Hadijuana, J., Venz, S., ... & Felix, R. (1999). D-galactose-based signal-enhanced color Doppler sonography of breast tumors and tumorlike lesions. Investigative radiology, 34(2), 109-115.

Marsden, J. R., Newton-Bishop, J. A., Burrows, L., Cook, M., Corrie, P. G., Cox, N. H., … Walker, C. (2010). Revised U.K. guidelines for the management of cutaneous melanoma 2010. British Journal of Dermatology, 163(2), 238–256. doi:10.1111/j.1365-2133.2010.09883.x.

Fernández Canedo, I., de Troya Martín, M., Fúnez Liébana, R., Rivas Ruiz, F., Blanco Eguren, G., & Blázquez Sánchez, N. (2013). Preoperative 15-MHz Ultrasound Assessment of Tumor Thickness in Malignant Melanoma. Actas Dermo-Sifiliográficas (English Edition), 104(3), 227–231. doi:10.1016/j.adengl.2012.06.025.

Lucas, V. S., Burk, R. S., Creehan, S., & Grap, M. J. (2014). Utility of High-Frequency Ultrasound. Plastic Surgical Nursing, 34(1), 34–38. doi:10.1097/psn.0000000000000031.

Botar Jid C, Bolboacă SD, Cosgarea R et al. (2015). Doppler ultrasound and strain elastography in the assessment of cutaneous melanoma: preliminary results. Medical Ultrasonography, 17(4): 509-514. doi:10.11152/mu.2013.2066.174.dus.

Botar-Jid, C. M., Cosgarea, R., Bolboacă, S. D., Şenilă, S. C., Lenghel, L. M., Rogojan, L., & Dudea, S. M. (2016). Assessment of Cutaneous Melanoma by Use of Very- High-Frequency Ultrasound and Real-Time Elastography. American Journal of Roentgenology, 206(4), 699–704. doi:10.2214/ajr.15.15182.

Crișan, D., Badea, A. F., Crișan, M., Rastian, I., Solovastru, L. G., & Badea, R. (2014). Integrative analysis of cutaneous skin tumours using ultrasonogaphic criteria. Preliminary results. Medical ultrasonography, 16(4), 285-290.

Dasgeb, B., Morris, M. A., Mehregan, D., & Siegel, E. L. (2015). Quantified ultrasound elastography in the assessment of cutaneous carcinoma. The British Journal of Radiology, 88(1054), 20150344. doi:10.1259/bjr.20150344.

Barcaui, E. de O., Carvalho, A. C. P., Lopes, F. P. P. L., Piñeiro-Maceira, J., & Barcaui, C. B. (2016). High frequency ultrasound with color Doppler in dermatology. Anais Brasileiros de Dermatologia, 91(3), 262–273. doi:10.1590/abd1806-4841.20164446.

Leucht, W. (1996). Teaching atlas of breast ultrasound. Thieme Stuttgart.

Marmur, E. S., Berkowitz, E. Z., Fuchs, B. S., Singer, G. K., & Yoo, J. Y. (2010). Use of High-Frequency, High-Resolution Ultrasound Before Mohs Surgery. Dermatologic Surgery, 36(6), 841–847. doi:10.1111/j.1524-4725.2010.01558.x.

Barcaui, E. de O., Carvalho, A. C. P., Valiante, P. M. N., & Barcaui, C. B. (2014). High-frequency ultrasound associated with dermoscopy in pre-operative evaluation of basal cell carcinoma. Anais Brasileiros de Dermatologia, 89(5), 828–831. doi:10.1590/abd1806-4841.20143176.

Olsen, L. O., Takiwaki, H., & Serup, J. (1995). High-frequency ultrasound characterization of normal skin. Skin thickness and echographic density of 22 anatomical sites. Skin Research and Technology, 1(2), 74–80. doi:10.1111/j.1600-0846.1995.tb00021.x.

Hinz, T., Wenzel, J., & Schmid-Wendtner, M.-H. (2011). Real-time tissue elastography: A helpful tool in the diagnosis of cutaneous melanoma? Journal of the American Academy of Dermatology, 65(2), 424–426. doi:10.1016/j.jaad.2010.08.009.


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DOI: 10.28991/SciMedJ-2020-0202-7

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