[Ultrasonographic and power Doppler appearance of locoregional metastases from cutaneous melanoma]. / Aspecto ecográfico y en power doppler de las metástasis macroscópicas locorregionales del melanoma cutáneo.

OBJECTIVE: To describe the morphological and vascular ultrasound findings of cutaneous melanoma locoregional metastasis, both in lymph nodes and in superficial soft tissues. To see if detection of these findings allows a sure diagnosis. MATERIALS AND METHODS: The morphological aspects of melanoma metastasis were evaluated with high-resolution ultrasound, and vascularisation by power color, by means the malignancy criteria previously described. RESULTS: 71 loco-regional metastasis were found, in 32 patients: 15 lymph node metastases (21.2%) and 56 soft tissues metastases (78.8%). All of them were histologic confirmation. In 19 cases metastasis were not detected by clinical evaluation. The lymph node metastasis had: low echogenicity (100%) with heterogeneous texture (66.7%); absence of echogenic hilus (93.3%); a ratio between longitudinal and transverse diameters<2 in most cases (86.2%); and peripheral or mixed vascularisation (86.6%). A statistic signification (p=0.049) was proved between L/T ratio and vascularisation type. Soft tissues metastases presented: a maximal diameter between 3-27 mm (mean: 6.91); oval or round shape, sometimes lobulate; well-defined margins (100%); low echogenicity (100%); heterogeneous texture (64.3%); and they showed vascularisation even in the smallest lesions (<5 mm). A statistic signification (p=0.006) was proved between the size and the vascularisation degree. CONCLUSION: US findings allow a suspicion diagnosis of melanoma locoregional metastasis even when metastasis was not detected in physical exam.

Aspecto ecográfico y en power doppler de las metástasis macroscópicas locorregionales del melanoma cutáneo / Ultrasonographic and power Doppler appearance of locoregional metastases from cutaneous melanoma

Objetivo. Describir las características ecográficas morfológicas y vasculares de las metástasis locorregionales del melanoma cutáneo, tanto ganglionares como en tejidos superficiales; observar si el reconocimiento ecográfico de estas lesiones permite el diagnóstico con alto grado de certeza. Material y métodos. Se valoró el aspecto morfológico en ecografía de alta resolución y la vascularización mediante power color, de las metástasis locorregionales de melanoma, aplicando los criterios de malignidad propios de estas lesiones, descritos en la literatura. Resultados. Se encontraron 71 metástasis locorregionales en 32 pacientes, 15 metástasis ganglionares (21,2%) y 56 metástasis de partes blandas (78,8%), que se confirmaron anatomopatológicamente. En 19 casos no fueron sospechadas clínicamente. Las metástasis ganglionares presentaron ecogenicidad baja (100%) con textura heterogénea (66,7%), ausencia de hilio ecogénico (93,3%), una relación entre el diámetro longitudinal y transverso < 2 (86,6%) y vascularización periférica o mixta (86,6%). Se demostró una relación estadística significativa (p = 0,049) entre el L/T ratio y el tipo de vascularización. Las metástasis de partes blandas presentaron un diámetro máximo entre 3-27 mm (media: 6,91), forma ovalada o redondeada, a veces lobulada, márgenes bien definidos (100%), ecogenicidad baja (100%), textura heterogénea (64,3%) y presencia de vascularización (100%), incluso en las lesiones más pequeñas (< 5 mm). Se demostró una relación estadística significativa (p = 0,006) entre el tamaño y el grado de vascularización. Conclusión. Las características ecográficas permiten el diagnóstico de sospecha de las metástasis locorregionales del melanoma cutáneo, incluso en aquéllas que no pueden ser sospechadas clínicamente

Objetive. To describe the morphological and vascular ultrasound findings of cutaneous melanoma locoregional metastasis, both in lymph nodes and in superficial soft tissues. To see if detection of these findings allows a sure diagnosis. Materials and methods. The morphological aspects of melanoma metastasis were evaluated with high-resolution ultrasound, and vascularisation by power color, by means the malignancy criteria previously described. Results. 71 loco-regional metastasis were found, in 32 patients: 15 lymph node metastases (21,2%) and 56 soft tissues metastases (78,8%). All of them were histologyc confirmation. In 19 cases metastasis were not detected by clinical evaluation. The lymph node metastasis had: low echogenicity (100%) with heterogeneous texture (66,7%); absence of echogenic hilus (93,3%); a ratio between longitudinal andtransverse diameters < 2 in most cases (86,2%); and peripheral or mixed vascularisation (86,6%). A statistic signification (p = 0,049) was proved between L/T ratio and vascularisation type. Soft tissues metastases presented: a maximal diameter between 3-27 mm (mean: 6,91); oval or round shape, sometimes lobulate; well-defined margins (100%); low echogenicity(100%); heterogeneous texture (64,3%); and they showedvascularisation even in the smallest lesions (< 5 mm). A statisticsignification (p = 0,006) was proved between the sizeand the vascularisation degree.Conclusion. US findings allow a suspicion diagnosis ofmelanoma locoregional metastasis even when metastasiswas not detected in physical exam (AU)