Differential Diagnosis of Malignant Melanoma and Benign Cutaneous Lesions by Ultrasound Analysis

Background:  The purpose of the study is to evaluate the assessment of ultrasound analysis in the differential diagnosis of skin melanoma and benign cutaneous lesions. Objective: 61 patients (23 men and 38 women) between 17 and 87 years of age, with melanomas, atheromas, hemangiomas, keratoses, and naevi were studied. Methods: High-frequency gray-scale ultrasound analysis, color Doppler, power Doppler, advanced dynamic flow, strain Elastography, digital Dermoscopy were performed in all cases. Results: In malignant melanoma cases we have mainly: sharp margins, hypoechoic, homogenous structure, absent of posterior shadowing, central and disorganized circulatory pattern with multiple peduncles. In some benign pathology, several ultrasound criteria were exclusive: microcalcifications are only in atheroma, posterior shadowing, and circular rim - in keratosis. The incidence of other ultrasound criteria can vary in atheroma, hemangioma, keratosis, and nevus. Tumor longitudinal and thickness relation were higher (7.9±1.96) than in all benign pathologies (2.1-4.8). The Elastography stiffness of the 26 skin melanomas was 2.95±0.18 and was higher than the group of 35 patients with all benign skin pathology (0.96±0.59), including atheroma (2.0±0.78), hemangioma (0.55±0.21), keratosis (1.21±0.21) and nevus (0.78±0.45). Conclusion: Multimodal approaches to exploring high-frequency ultrasound analytic criteria can be helpful in the differential diagnosis of malignant melanoma and benign cutaneous lesions.