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 Table of Contents  
Year : 2019  |  Volume : 14  |  Issue : 3  |  Page : 265-267

Malignant melanoma of chest wall: Ultrasonography, doppler, and elastography imaging with pathological correlation

Department of Radiodiagnosis, Jawaharlal Nehru Medical College, Wardha, Maharastra, India

Date of Submission26-Jun-2019
Date of Decision22-Jul-2019
Date of Acceptance30-Jul-2019
Date of Web Publication2-May-2020

Correspondence Address:
Dr. Suresh Phatak
Department of Radiodiagnosis, Jawaharlal Nehru Medical College, Swaangi (Meghe), Wardha - 442 001, Maharastra
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jdmimsu.jdmimsu_98_19

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Melanoma arises from melanocytes of the basal layer of epidermis and may originate on the trunk, extremities, face, eyes, and rarely from other visceral organs. Eighty percent of malignant melanoma is due to excessive sunlight mainly in childhood. Even the least common skin cancer malignant melanoma is the almost deadly. Earlier diagnosis and management of primary cutaneous melanoma mainly relied on clinical and histological characteristics but in recent years, there has been a tremendous growth in the usage of ultrasound, Doppler, and elastography for noninvasive evaluation of melanoma. We present a case of a 50-year-old female who presented with a history of blackish nodular mass over the right chest wall. Gray-scale ultrasound, color Doppler, and sonoelastography findings are discussed.

Keywords: Color Doppler, malignant melanoma of breast, sonoelastography, ultrasound

How to cite this article:
Singh R, Phatak S. Malignant melanoma of chest wall: Ultrasonography, doppler, and elastography imaging with pathological correlation. J Datta Meghe Inst Med Sci Univ 2019;14:265-7

How to cite this URL:
Singh R, Phatak S. Malignant melanoma of chest wall: Ultrasonography, doppler, and elastography imaging with pathological correlation. J Datta Meghe Inst Med Sci Univ [serial online] 2019 [cited 2021 Jan 27];14:265-7. Available from: http://www.journaldmims.com/text.asp?2019/14/3/265/283607

  Introduction Top

Cutaneous malignant melanoma constitutes 4%–11% of all skin cancer.[2] The staging of malignant melanoma is mainly based on the Breslow classification. It relies on tumor infiltration (depth) by histology in different cutaneous layers giving a measurement of microscopic invasion from stratum granulosum of the epidermis to the deepest portion of the tumor. Because of recent advances in ultrasound technology, we are able to observe cutaneous layers with good resolution.

  Case Report Top

A 50-year-old female came to the hospital with a history of raised black irregular rough-surfaced mass on the chest wall in the region of upper outer quadrant of her right breast. She had no complaints of pain or discharge from the lesion or bleed on touch. She was referred to radiology department for ultrasonography examination of the lesion.

On grayscale ultrasound revealed hyperechoic mass with peripheral hypoechoic halo in subcutaneous plane size 28 mm × 19 mm in the right upper chest wall [Figure 1] on the skin which was very vascular on Doppler [Figure 2]. Breast parenchyma appeared normal. The left breast appeared normal. On strain elastography, stiff color (dark blue) identified in the lesion with strain ratio (SR) of 6.11 [Figure 3]. Biopsy from the lesion revealed features of malignant melanoma. The right axilla showed multiple lymph nodes. Larger one measuring 35 mm × 17.2 mm with loss of fatty hilum and cystic changes within [Figure 4]. Doppler study of this lymph node revealed peripheral hypervascularity [Figure 5].
Figure 1: Gray-scale ultrasound revealed hyperechoic solid mass of size 29 mm × 18 mm in the right upper outer quadrant

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Figure 2: Color Doppler revealed increased vascularity in a solid mass

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Figure 3: On elastography, blackish mass shows mostly stiff tissue (dark blue on elastography color scale) with a strain ratio of, indicating malignancy

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Figure 4: The right axilla lymph node of size 35 mm × 17.2 mm with loss of fatty hilum and cystic changes

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Figure 5: The right axillary lymph node showing increased vascularity

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  Discussion Top

Early lesions usually present oval or fusiform shape and hypoechogenicity on sonography. Mostly, these lesions infiltrate the dermis and show increased blood flow in the tumor.

The peak systolic arterial velocity of vessels in tumor (cm/sec) may provide an idea of angiogenic power of the tumor that can correlate with its metastatic potential.[2] Color Doppler helps in the detection of tumor flow in the superficial melanoma metastases to determine tumor and vessel size and vessel number that potentially affect signal detection. Using multichanneled color Doppler machines having different frequency probes that reach frequencies ≥15 MHz echostructure of the skin layers can be clearly seen.[2] While using multi-channeled color Doppler ultrasound equipment with different frequency probes that range from 10 to 15 MHz, it has already been seen that ultrasound is capable of differentiating melanomas measuring greater or lesser than 1 mm of thickness which is important for requiring. For example, a sentinel lymph node procedure that is indicated in melanomas measuring more than 1 mm thick.[2] Since melanoma contains melanin as a component that contains stable free paramagnetic radicals which have paramagnetic effect resulting in shortening of T1 and T2 relaxation times. Melanoma possesses a high signal on T1-weighted images and a low signal on T2-weighted images on magnetic resonance imaging.[1]


Strain ratio measurement

SR measurement is a semi-quantitative method of lesion assessment. Calculation of the SR value is mainly based on determining the average strain measured in a lesion and comparing it to the average strain of a similar area of fatty tissue. Using proprietary software, the average strain of the lesion is determined by selecting a region of interest encompassing the lesion; the value of SR increases as a function of the relative stiffness of the target lesion. As the SR increases, the likelihood of malignancy is also higher.[4]

  Conclusion Top

Ultrasound can play a major role for assessing characteristics of the cutaneous melanoma,[3] such as depth and vascularity. Color Doppler and elastography further help in accurate characterization of cutaneous malignant melanoma helping in patient management.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Kim Y, Cho KR, Seo BK, Woo OH, Lee JH, Cho SB. Radiologic findings of metastatic malignant melanoma of the breast: Mammographic, sonographic, dynamic contrast-enhanced breast MRI, and 18F-FDG PET-CT features. Iran J Radiol 2017;14. Available from: https://doi.org/10.5812/iranjradiol.38392. [Last accessed on 2019 Jul 17].  Back to cited text no. 1
Wortsman X. Sonography of the primary cutaneous melanoma: A review. Radiol Res Pract 2012;2012.  Back to cited text no. 2
Botar-Jid CM, Cosgarea R, Bolboacă SD, Şenilă SC, Lenghel LM, Rogojan L, et al. Assessment of Cutaneous Melanoma by Use of Very- High-Frequency Ultrasound and Real-Time Elastography. AJR Am J Roentgenol 2016;206:699-704.  Back to cited text no. 3
Zhi H, Xiao XY, Yang HY, Wen YL, Ou B, Luo BM, et al. Semi-quantitating stiffness of breast solid lesions in ultrasonic elastography. Acad Radiol 2008;15:1347-53.  Back to cited text no. 4


  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]


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