Pennasilico G, Santini A, Bono R, Cacciaguerra M G, Puddu P, Falappa P
Istituto Dermopatico dell'Immacolata, IRCCS, Roma.
Radiol Med. 1994 Oct;88(4):388-91.
The authors report on the preoperative evaluation of melanoma thickness with very high frequency US probes (20 MHz). Thirty patients with clinical suspicion of melanoma were examined preoperatively with US. The high quality of the images obtained with 20-MHz US probes allowed the lesions involving the superficial derma or, in more advanced cases, all derma, to be demonstrated and tumor thickness to be measured accurately. The latter is a major prognostic factor and indeed Breslow's classification is based on tumor thickness. The preoperative US study of melanoma thickness allows the surgeon to plan excision depth, which is necessary for accurate and safe tumor resection, that is, whose margins are proportionate to melanoma thickness. In the 30 patients submitted to preoperative US measurements of tumor thickness, US and histologic findings were in agreement. US overestimated melanoma thickness by 7 to 11%, which however had no impact on prognosis and surgical planning. While US can differentiate melanomas from other types of benign or malignant pigmented skin lesions such as blue nevus, pigmented basalioma or pigmented seborroic cheraosis, no unquestionable US signs have been found yet to differentiate melanoma from nevus, which makes US useless for the differential diagnosis. Nonetheless, surgeons can use preoperative US to adapt the exeresis of melanoma to its actual severity and to reduce scars to a minimum. Possible skin metastases can also be detected by US and thus removed.
作者报告了使用超高频率超声探头（20MHz）对黑色素瘤厚度进行的术前评估。30例临床怀疑为黑色素瘤的患者在术前接受了超声检查。20MHz超声探头获得的高质量图像能够显示累及浅表真皮的病变，在更晚期的病例中还能显示累及全层真皮的病变，并能准确测量肿瘤厚度。肿瘤厚度是一个主要的预后因素，实际上布雷斯洛分类就是基于肿瘤厚度。黑色素瘤厚度的术前超声研究能让外科医生规划切除深度，这对于准确、安全地切除肿瘤是必要的，也就是说，切除边缘要与黑色素瘤厚度成比例。在30例接受术前肿瘤厚度超声测量的患者中，超声和组织学检查结果一致。超声对黑色素瘤厚度的高估为7%至11%，但这对预后和手术规划没有影响。虽然超声能够将黑色素瘤与其他类型的良性或恶性色素沉着性皮肤病变，如蓝痣、色素性基底细胞瘤或色素性脂溢性角化病区分开来，但尚未发现明确的超声征象能将黑色素瘤与痣区分开来，这使得超声在鉴别诊断中无用。尽管如此，外科医生可以利用术前超声根据黑色素瘤的实际严重程度调整切除范围，并将疤痕减至最小。超声还能检测出可能的皮肤转移灶并将其切除。
