Maj M, Warszawik-Hendzel O, Szymanska E, Walecka I, Rakowska A, Antczak-Marczak M, Kuna P, Kruszewski J, Nasierowska-Guttmejer A, Litniewski J, Nowicki A, Olszewska M, Rudnicka L
Department of Dermatology, Medical University of Warsaw, Warsaw, Poland -
G Ital Dermatol Venereol. 2015 Oct;150(5):595-601.
The aim of our study was to assess the usefulness of high frequency ultrasonography in the diagnosis of melanoma.
We examined 84 patients with suspicious melanocytic skin lesions, including 19 cases of melanoma. In vivo high-resolution ultrasonography (30 MHz) was performed prior to excision.
In ultrasound scans early melanomas presented as flat oval or fusiform shaped structures and were clearly demarcated, while advanced melanomas were characterized by a roundish shape with less distinct borders. The ultrasonographic thickness of in situ melanomas ranged from 0.02 to 0.85 mm. In the case of invasive tumors, the mean thickness evaluated by high frequency ultrasonography was 10.7% higher compared to the Breslow Score (1.44±0.8 mm and 1.3±0.88 mm, respectively). In all melanomas of Breslow Score of 1 mm or more ultrasound also indicated a Breslow Score of 1 mm or more.
High frequency ultrasound examination has limited value in differential diagnosis of melanoma, but it gives a clear picture of the size and depth of the tumor. The method should be used as a complementary method (after dermoscopy and, where applicable, reflectance confocal microscopy) in preoperative evaluation of the tumor. In some cases of locally advanced melanoma, ultrasound examination may allow to reduce the number of surgical procedures and favor the decision of a one-time surgical treatment (removal of primary tumor and sentinel lymph node biopsy at the same time).
本研究旨在评估高频超声在黑色素瘤诊断中的实用性。
我们检查了84例有可疑黑素细胞性皮肤病变的患者，其中包括19例黑色素瘤患者。在切除术前进行了体内高分辨率超声检查（30兆赫）。
在超声扫描中，早期黑色素瘤表现为扁平椭圆形或梭形结构，边界清晰，而晚期黑色素瘤的特征是形状呈圆形，边界不太明显。原位黑色素瘤的超声厚度范围为0.02至0.85毫米。对于浸润性肿瘤，高频超声评估的平均厚度比Breslow评分高10.7%（分别为1.44±0.8毫米和1.3±0.88毫米）。在所有Breslow评分为1毫米或以上的黑色素瘤中，超声也显示Breslow评分为1毫米或以上。
高频超声检查在黑色素瘤的鉴别诊断中价值有限，但它能清晰显示肿瘤的大小和深度。该方法应作为一种补充方法（在皮肤镜检查之后，适当时结合反射式共聚焦显微镜检查）用于肿瘤的术前评估。在一些局部晚期黑色素瘤病例中，超声检查可能有助于减少手术次数，并有利于做出一次性手术治疗（同时切除原发肿瘤和前哨淋巴结活检）的决定。
