Sonography for Locoregional Staging and Follow-up of Cutaneous Melanoma

Catalano, Orlando; Setola, Sergio Venanzio; Vallone, Paolo; Raso, Mauro Mattace; D'Errico, A

doi:10.7863/jum.2010.29.5.791

Cited by 38 publications

(44 citation statements)

References 34 publications

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“…Although it has the limitation of missing micrometastases (intranodal deposits <2 mm), high‐resolution sonography has proven sensitive and specific in detecting this regional spreading, particularly when it is combined with the color and power Doppler assessment of nodal vasculature and with the sonographically guided fine‐needle cytologic analysis 6 – 8 , 16 , 17 …”

Section: Discussionmentioning

confidence: 99%

“…A color Doppler correlation was available for 78 of the 84 lesions. The images had been obtained using a standardized examination method 16 and a MyLab 70 XVG scanner (Esaote SpA, Genoa, Italy) equipped with high‐resolution multifrequency transducers. In our institution, we first scan the skin around the primary tumor (or its scar), 10 cm all around, to rule out satellite and in‐transit metastases.…”

Section: Methodsmentioning

confidence: 99%

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Previously Reported Sonographic Appearances of Regional Melanoma Metastases Are Not Likely Due to Necrosis

Catalano

Voit

Sandomenico

et al. 2011

Journal of Ultrasound in Medicine

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onography is being increasingly used worldwide in the evaluation of locoregional tumor spreading in patients with cutaneous melanoma. Approximately two-thirds of patients with metastatic-stage melanoma have regional lymphatic lesions, which are satellite (within 2 cm from the primary tumor or its scar), in transit (>2 cm from the primary site), or nodal (regional lymphatic stations). 1 Consequently, early detection and proper characterization of these regional metastases are key steps in both the Orlando Catalano, MD, Christiane Voit, MD, Fabio Sandomenico, MD, Ylenia Mandato, MD, Mario Petrillo, MD, Renato Franco, MD, Gerardo Botti, MD, Corrado Caracò, MD, Nicola Mozzillo, MD, Adolfo Gallipoli D'Errico, MD Received February 20, 2011, from the Departments of Radiology (O.C., F.S., A.G.D.), Pathology (R.F., G.B.), and Surgery, Melanoma and Soft Tissues (C.C., N.M.) ORIGINAL RESEARCHObjectives-Sonography has proven to be a reliable tool in early detection of lymph node and in-transit cutaneous-subcutaneous metastases. Those metastases normally appear as hypoechoic or even anechoic lesions on sonography. It has been assumed that this appearance is due to necrosis of the lesions, but so far, that assumption has never been proven. The purpose of this retrospective study was to evaluate whether the hypoechoic appearance of melanoma metastasis is really due to tumor necrosis.Methods-From a radiographic database, we retrieved 212 melanoma cases imaged with sonography over a 2-year period for disease staging or follow-up. We selected 37 positive cases with 84 nodal and extranodal (satellite and in-transit) metastatic lesions and reviewed the sonograms and pathologic slides (slides available for 40 of 84 lesions). We retrospectively assessed the vascularization pattern (color Doppler images available for 78 of 84 lesions), categorizing it as poor, intermediate, or consistent. We also looked for necrosis on the histopathologic material, categorizing it into scores of 0, 1, 2, and 3 for absence of necrosis, less than 20% necrosis, 20% to 40% necrosis, and greater than 40% necrosis, respectively.Results-Despite their gray scale appearance, most melanoma lesions were vascularized on color Doppler imaging and showed limited necrosis at histopathologic analysis. Consistent vascularization on Doppler imaging, excluding substantial necrosis, was found in 44 of 78 lesions (56.4%). Poor vascularization on Doppler imaging, suggesting necrosis, was present in only 14% of the lesions. Substantial necrosis (scores of 2 and 3) was found pathologically in only 10% of the lesions.Conclusions-Necrosis seems to be an uncommon event in melanoma metastasis and is probably not the basis for its low-level echo pattern on sonography. The hypoechoic appearance is very typical of melanoma metastasis and is likely due to massive melanomatous infiltration (with the poor echo reflectivity of melanin). However, confirmation in larger pathologically proven series is required.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Previously Reported Sonographic Appearances of Regional Melanoma Metastases Are Not Likely Due to Necrosis

Catalano

Voit

Sandomenico

et al. 2011

Journal of Ultrasound in Medicine

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“…[36] These satellite and in-transit metastases develop within dermal and subdermal lymphatics before reaching the regional lymph nodes, and studies have shown that HRUS is more sensitive and specific than palpation in the detection of these metastases. [3638] Catalano et al ., in their study of lymph node metastasis in patients with cutaneous melanoma have concluded that HRUS can replace the complex and expensive sentinel lymph node biopsy procedure in the staging of patients with melanoma as cases with positive nodes on HRUS can directly undergo radical surgery with lymphadenectomy. [39] USG is also used during patient follow-up, having been proven more accurate than physical examination in detecting locoregional relapses.…”

Section: Instrumentationmentioning

confidence: 99%

High-resolution ultrasound imaging of cutaneous lesions

Mandava

Ravuri

Konathan

2013

Indian Journal of Radiology and Imaging

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High-resolution variable frequency ultrasound imaging is increasingly being used in the noninvasive evaluation of various cutaneous diseases. It plays a complimentary role to physical examination in the assessment of cutaneous lesions. It is the only imaging modality useful in the evaluation of superficial cutaneous lesions that are too small to be evaluated on computed tomography (CT) or magnetic resonance imaging (MRI) and is helpful in reducing invasive procedures like biopsies and fine needle aspirations. In this article, we seek to describe the relevance and basic principles of cutaneous ultrasound, imaging findings of normal skin, current applications of high-resolution ultrasound in the diagnosis and management of various dermatological conditions, along with the features of some commonly encountered lesions.

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“…This is true for both cutaneous lesions, which after treatment may leave behind hyperpigmented regions of difficult classification (see, e.g., Fig. 2E), and subcutaneous lesions, as sonography or CT may still generate abnormal signals in lesions devoid of tumor cells (39), where heavy lymphocytic infiltration has occurred or necrotic/fibrotic areas have developed. This suggests that the existing response evaluation guidelines are not optimal and raises the need for the scientific community to consider new, ad hoc evaluation criteria and study endpoints for this pathology and treatment modality.…”

Section: Discussionmentioning

confidence: 99%

Intralesional Treatment of Stage III Metastatic Melanoma Patients with L19–IL2 Results in Sustained Clinical and Systemic Immunologic Responses

Weide¹,

Eigentler²,

Pflugfelder³

et al. 2014

Cancer Immunology Research

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L19-IL2 is a recombinant protein comprising the cytokine IL2 fused to the single-chain monoclonal antibody L19. In previous studies, intralesional injection with IL2 has shown efficacy for the locoregional treatment of cutaneous/subcutaneous metastases in patients with advanced melanoma. The objectives of this study were to investigate whether (i) intralesional delivery of a targeted form of IL2 would yield similar results, with reduction of injection frequency and treatment duration; and (ii) systemic immune responses were induced by the local treatment. Patients with stage IIIB/IIIC melanoma and cutaneous/subcutaneous injectable metastases received weekly intratumoral injections of L19-IL2 at a maximum dose of 10 MIU/week for 4 consecutive weeks. Tumor response was evaluated 12 weeks after the first treatment. Twenty-four of 25 patients were evaluable for therapyinduced responses. A complete response (CR) by modified immune-related response criteria (irRC) of all treated metastases was achieved in 6 patients (25%), with long-lasting responses in most cases (5 patients for !24 months). Objective responses were documented in 53.9% of all index lesions [44.4% CR and 9.5% partial responses (by irRC)], and 36.5% of these remained stable, while 9.5% progressed. Toxicity was comparable with that of free IL2, and no serious adverse events were recorded. A significant temporary increase of peripheral regulatory T cells and natural killer cells, sustained increase of absolute CD4 þ lymphocytes, and decrease of myeloid-derived suppressor cells were observed upon treatment. Finally, we recorded encouraging data about the progression time to distant metastases and overall survival. Cancer Immunol Res; 2(7); 668-78. Ó2014 AACR.

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Sonography for Locoregional Staging and Follow-up of Cutaneous Melanoma

Cited by 38 publications

References 34 publications

Previously Reported Sonographic Appearances of Regional Melanoma Metastases Are Not Likely Due to Necrosis

Previously Reported Sonographic Appearances of Regional Melanoma Metastases Are Not Likely Due to Necrosis

High-resolution ultrasound imaging of cutaneous lesions

Intralesional Treatment of Stage III Metastatic Melanoma Patients with L19–IL2 Results in Sustained Clinical and Systemic Immunologic Responses

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