Background: Cutaneous melanoma is one of the most severe skin diseases. Nodular melanoma
is the second melanoma subtype in order of frequency. The prognosis of skin melanoma depends
on the vertical growth of the tumor (Breslow index). For this measurement, excisional biopsy is
strongly recommended. This is, however, an invasive procedure and may cause damage to the lymphatic
drainage system. The HFUS system, , can be extremely useful for determining tumor thickness
in the preoperative phase, given its high resolution capacity. The aim of this preliminary study is to
define the role of HFUS for the nodular skin melanoma Breslow thickness in adults before surgery by
making a comparison with histological features.
Methods: In this study, 14 melanocytic lesions (8 male and 6 female) were evaluated with dermatoscopic
clinical features strongly indicative of nodular melanoma. Out of these, excisional biopsy of 7
lesions was requested. The ultrasounds were performed preoperatively. The images were acquired
through the first ultrasound scanner with ultra-high frequency probes (range from 50MHz to 70 MHz)
available on the market under the EEC mark (Vevo "MD, FUJIFILM Visual Sonics, Amsterdam, the
Netherlands) equipped with a linear probe of 50-70 MHz.
Results: From the ultrasonographic analysis of 14 nodular melanoma thickness was determined for the
presence of two hyperechogenic laminae, separated by a hypo / anechoic space. The twelve lesions
were in situ while the other two lesions showed ultrasonography for example; the satellite lesions (less
than two centimeters from the primary lesion) and in transit (localizable to more than two centimeters
from the primary lesion). Four of these lesions were ulcerated. A comparsion was made the 7 lesions
on between the thickness calculated with this method, and that obtained on the bioptic piece. The presence
of a positive concordance has been evident in all of the cases.
Conclusion: If further studies are needed to support its widespread clinical use, its is believed that, in
expert hands and with an interdisciplinary team, HFUS is already capable to reliably calculate a
Breslow index in a large majority of patients with cutaneous melanoma.