Interventional Ultrasound in Dermatology: A Pictorial Overview Focusing on Cutaneous Melanoma Patients

Abstract

Cutaneous melanoma incidence is increasing worldwide, representing an aggressive tumor when evolving to the metastatic phase. High-resolution ultrasound (US) is playing a growing role in the assessment of newly diagnosed melanoma cases, in the locoregional staging prior to the sentinel lymph-node biopsy procedure, and in the melanoma patient follow-up. Additionally, US may guide a number of percutaneous procedures in the melanoma patients, encompassing diagnostic and therapeutic modalities. These include fine needle cytology, core biopsy, placement of presurgical guidewires, aspiration of lymphoceles and seromas, and electrochemotherapy.

Keywords: cutaneous melanoma; general ultrasound; intervention; nonvascular interventional radiology; oncologic imaging; ultrasound.

Figure 1

Primary melanoma tumor of the leg. Clinical photograph (A). High‐resolution, B‐mode scan showing a homogeneously, hypoechoic thick lesion (B). Superb microvascular imaging scan demonstrating an intense tumor vascularization (C).

Figure 2

A 3‐mm large, in‐transit melanoma metastasis of the arm. B‐mode (left) and superb microvascular imaging scan (right). Ultrasound allows depicting the small, hypoechoic, subcutaneous nodule and demonstrating the presence of flow signals inside the metastasis.

Figure 3

Regional lymph‐node melanoma metastasis to the groin. B‐mode (left) and directional power‐Doppler imaging scan (right). Large, hypoechoic tumor deposit displacing the anatomic and the vascular hilum.

Figure 4

Ultrasound‐guided fine‐needle aspiration cytology of an in‐transit melanoma metastasis.

Figure 5

Ultrasound‐guided fine‐needle aspiration cytology of a regional lymph‐node melanoma metastasis to the axilla.

Figure 6

Gross appearance of the fine‐needle aspiration cytology smear of the slide. The brownish appearance is already diagnostic for melanoma metastasis.

Figure 7

Lymph‐node metastatic, epithelioid melanoma (PAP 60×). Tumor cells show a marked nuclear pleomorphism, prominent nucleoli, and nuclear pseudoinclusions.

Figure 8

Lymph‐node metastatic, pigmented melanoma (PAP 60×). Neoplastic cells are characterized by marked nuclear pleomorphism, prominent nucleoli, and intracytoplasmatic deposits of melanic pigment.

Figure 9

Ultrasound (US)‐guided seroma aspiration. US scan before and after percutaneous aspiration of the 2‐cm collection.

Figure 10

Ultrasound‐guided placement of a pre‐surgical guidewire in a supraclavicular metastasis.

Figure 11

Repositionable guidewire device.