Reginelli Alfonso, Belfiore Maria P, Russo Anna, Turriziani Fabrizio, Moscarella Elvira, Troiani Teresa, Brancaccio Gabriella, Ronchi Andrea, Giunta Emilio, Sica Antonello, Iovino Francesco, Ciardiello Fortunato, Franco Renato, Argenziano Giuseppe, Grassi Roberto, Cappabianca Salvatore
Section of Radiology and Radiotherapy, Department of Precision Medicine, University of Campania "L. Vanvitelli"; Naples, Italy.
Section of Dermatology, Department of Preventive Medicine, University of Campania "L. Vanvitelli"; Naples, Italy.
Curr Radiopharm. 2020;13(1):48-55. doi: 10.2174/1874471012666191007121626.
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.
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.
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.
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.
皮肤黑色素瘤是最严重的皮肤疾病之一。结节性黑色素瘤是按发病率排序的第二大黑色素瘤亚型。皮肤黑色素瘤的预后取决于肿瘤的垂直生长情况（ Breslow指数）。对于该测量，强烈建议进行切除活检。然而，这是一种侵入性操作，可能会对淋巴引流系统造成损害。鉴于其高分辨率能力，高频超声（HFUS）系统在术前阶段确定肿瘤厚度方面可能非常有用。这项初步研究的目的是通过与组织学特征进行比较，确定HFUS在成人结节性皮肤黑色素瘤术前Breslow厚度测定中的作用。
在本研究中，对14个具有强烈提示结节性黑色素瘤皮肤镜临床特征的黑素细胞病变（8例男性和6例女性）进行了评估。其中，要求对7个病变进行切除活检。术前进行超声检查。图像通过市场上可获得的第一台配备50 - 70 MHz线性探头的、符合欧盟标准（Vevo “MD，富士胶片视觉超声公司，荷兰阿姆斯特丹）的超高频探头（范围为50MHz至70MHz）的超声扫描仪采集。
通过对14个结节性黑色素瘤的超声分析，确定存在两个高回声层，中间由一个低回声/无回声空间分隔。12个病变为原位病变，另外两个病变显示有例如卫星病变（距原发病变小于两厘米）和移行病变（可定位在距原发病变两厘米以上）。这些病变中有4个发生了溃疡。对这7个病变用该方法计算的厚度与活检标本上获得的厚度进行了比较。在所有病例中均明显存在正一致性。
如果需要进一步研究来支持其广泛的临床应用，据信在专家手中并借助跨学科团队，HFUS已经能够在大多数皮肤黑色素瘤患者中可靠地计算Breslow指数。
